Registration Form

Registering for course 

Submit order by e-mail (complete following), Fax (972-527-6073), Call (972-527-3687), or Mail (All registrations are mailed to: EMTS Registrations/Admin - 7000 Independence Pkwy, Suite 160-238 - Plano, TX 75025)

*Name Last First
Medical Skill Level  
Company/Facility
*E-Mail Once processed you will receive an e-mail confirming enrollment into the program.
*Phone
Fax

*Mailing Address for Study Material

Street   Apt #

City   State    Zip Code 

*Course Title
*Course Start Date , 2011/2012 course
*Total $$$ Amount of payment to be applied Indicate if you are paying 1/2 ($1,675.00 minimum deposit) to reserve a seat at this time or you may choose to pay the entire amount at this time.
*Criminal History Have you ever been convicted of a misdemeanor or felony? 
*Payment Options 
Credit Card Payment Credit Card Type

Card #

Expiration month/year Note: Paying by credit card on-line reserves a seat in the course immediately.

Enter the 3 digit number code on back of card.

 

 
Check# or MO# Enter Check # or MO # Complete this form on-line then press "Submit Registration" at bottom of page.  Then print the confirmation page.  Mail the confirmation page (or copy) with payment to: EMTS ADMIN - 7000 Independence Pkwy, Suite 160-238 - Plano, TX 75025. 
PO #Not an option for this course.
  By submitting payment you agree to the refund policies. Half of the course fee is due in advance to reserve a seat in the course. This fee is non-refundable. The remaining balance is due in full on the first day of class, unless other arrangements have been made in advance. Seat deposits are taken on a first come first serve basis. If the course enrollment is full the entire deposit is not deposited by EMTS and is returned immediately.  If not completing this form on-line with payment the application and check/money order deposits should be mailed to EMTS' administration offices at 7000 Independence Parkway, Suite 160-238 - Plano, TX 75025. The seat deposit will be applied toward tuition, insurance and textbooks.