EMR Card Application 2024

Andrew County Ambulance District Emergency Medical Responder Card (ACAD-EMR) Application
Full Name*
Email*
example@example.com
Phone*
Department*
Choose Which you are applying with:*

Initial EMR TrainingRenewal CourseTransitional LicenseAdministrator Approved
Initial Course Completion Date*

MonthDayYear
Date
Renewal Course Completion Date*

MonthDayYear
Date
License Type*
License Expires*

MonthDayYear
Date
BLS Card Expires*

MonthDayYear
Date
Applicant Signature

Clear
Application Date

MonthDayYear
Date
Each Applicant must be a member of the above named department. You must be an active member of an EMR Participating Fire Department or Ambulance District First Responder in order to utilize your skills as an EMR.
Upload Supporting Documents (Don't forget Current BLS Card)*

Cancelof
Andrew County Ambulance District ~ 206 N Third St. ~ Savannah, MO 64485

For any questions visit edu.academs.org or call 816-897-0549
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