ASVAC CME Registration Form

Dear EMT,

As we move towards digitizing our CME process please fill the following application form if you are interested in submitting your CME via ASVAC. This also applies to those EMTs who are currently in our program.

If you have any queries or would like to withdraw, please let Tony know directly at Training@asvac.org
ASVAC CME Registration

This information is required for submission of CME to the NYS DOH. Please ensure matches data submitted to the NYS DOH in the past.
CFR’s, EMTs, AEMT’s, EMT-Critical Care Technicians and Paramedics may participate in the ASVAC CME Recertification Program if they are:
a) currently certified in New York State;
b) in continuous practice;
c) are a member/employee of an agency registered in the CME program authorized to provide the level of care for which the participant is seeking recertification; and
d) meet all other Bureau of EMS program requirements as stated in this manual.

Individual participation in the CME program is purely voluntary and participants may withdraw at any time.
EMT Number
License expiry Date

MonthDayYear
Date
Name

First NameLast Name
Level of EMT
Last 4 digits of SSN
I confirm there are no changes to the email address, mailing address, and phone number currently on file and that these match the records submitted to the DOH.
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Should be Empty:

Dear EMT,

As we move towards digitizing our CME process please fill the following application form if you are interested in submitting your CME via ASVAC. This also applies to those EMTs who are currently in our program.

If you have any queries or would like to withdraw, please let Tony know directly at Training@asvac.org

ASVAC CME Registration