RTCEMT Online Registration Form
Use the following form to register for our upcoming courses.

▶ PLEASE NOTE: Seats will not be reserved until a deposit is received. Deposits are to be sent to:
The Regional Training Center for EMT's Inc.
PO Box 126, Oakland Gardens, NY 11364
- or -
It can be paid online by credit/debit card at: https://www.mkt.com/rtcemt


✱ a red asterisk indicates a required field
Sign me up for *
NOTE: If you are a CFR or EMT already, please select the "refresher" program.
Last Name *
First Name *
Middle Name Initial
(optional)
Gender *
Student's Email Address *
IMPORTANT: An autoreply email will be sent to this address upon your completion of this form. We will also use this email address to communicate with the student during the program for various program info & online assignments. Your email will NOT be sold to any third-party advertising agencies.
Student's Mobile Phone Number *
IMPORTANT: During the program, various assignment reminders and program notifications will be sent this student's mobile phone number via SMS text messages.
Home Phone Number
Home Address *
Please include all of the following info: House Number - Street Name, Apt/Unit, City, State, and Zip Code
Birthday
MM
/
DD
/
YYYY
Last 4 digits of Social Security Number
Are you a former student at our program? *
Affiliation
volunteer corps, ambulance company, fire department, hospital, school, if any
How did you hear about us? *
Comments
Your current or past EMT Certification Information
✱ filled out by Refresher student only
NYS EMT/CFR Certification Number
Certification Expiration Date
MM
/
DD
/
YYYY
Submit
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