2026 Spring Lewiston AEMT Registration
Full Name
*
First Name
Last Name
Student E-mail
*
example@example.com
Phone Number
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Do you have an active CPR certification?
*
Yes
No
EMS License Number:
*
Are you affiliated with a service?
*
Yes
No
If yes, please list the service below:
*
Why do you want to take this course?
*
Submit
Should be Empty: