REGISTRATION

Pelham Training Course Registration Form

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Upon receipt of your registration form, Pelham Training will send a welcome letter with attachments via e-mail to the e-mail address you have listed on your registration form. Depending on how you have your e-mail inbox configured, this important email may go to your junk mail folder. If you have not received your welcome letter within 2 business days of transmitting your application to us, please check your junk mail folder. If after doing so you still have not received your welcome packet, please contact us immediately.

All students attending EMT class must apply for a PSID # from the Indiana Department of Homeland Security. You MUST have your PSID # prior to the beginning of class. Students attending EMT class from places outside Indiana are still required to have a PSID # prior to the beginning of class. There are no exceptions. Complete information on how to apply for your PSID # will be included with your welcome letter.

Methods of Payment: A down payment to hold your seat is required, payable by phone. The remaining balance is due on or prior to the first day of class. Paramedic payment schedules will be included in your acceptance letter.

Student Information (All Fields Required)

First and Last Name *

First

Last Name *

Last

Address *

City *

State *

Zip Code *

County (If Indiana Resident) *

Age *

Date of Birth *

Shirt Size * Please select one... Small Medium Large X-Large 2X-Large 3X-Large

Cell Phone *

Email *

Which Course are you interested/Registering in? *

EMT Basic Accelerated

Paramedic Program

EMT Practical Exam

Paramedic Practical Exam

Wilderness Upgrade Course

Paramedic Refresher Week

Remedial Hours

Critical Care Course

Trauma Lanes

ACLS

ACLS Refresher

Law Enforcement Tactical Trauma

OtherOther

Preferred Method of contact *

Email

Phone

Additional Information, Questions or Concerns

Submit

 Phone registration hours are Monday – Friday from 9 a.m. to 4 p.m. at 812.381.9001