PRYOR OK - ACLS &/or PALS Course
PRYOR OK Location for CPR                         Mike Miller will be Your Instructor
Sign in to Google to save your progress. Learn more
Email *
Location - If you would like us to meet you at a different location please be aware there could be an extra charge for the drive. *
Required
Which EMT Course.  *
Required
Urgency for the Class. Travel distance, urgency or special circumstances may incur additional charges. *
Required
First Name *
Last Name *
Phone *
Alternate Email  (not required)
Address
City
Region/State
This refer to state/province field in Google Contacts
Zip code
Date of Birth *
MM
/
DD
/
YYYY
How would you like us to contact you for scheduling? 
Payment *
You are welcome to pay by cash, money order or check the day of the class, but if the class should fill you may lose your seat. A $15.00 Registration fee must be paid to save a place in a class. The fee is include in the tuition. Classes are set up by the instructor & their availability.  We will be contacting you about scheduling, but please understand that it could take up to 30 days to schedule a class. A refund may be offered if OKEMSTA or our instructors are unable to meet your request.
General or Instructor Questions or Comments below 
Feel free to reach out by phone, text or email to Mike at mike@okemsta.com or 918-944-0954.  
For Instructor Questions: Tonya at tjordan4@cox.net or 918-694-3690
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
This form was created inside of Oklahoma EMS Training Academy.

Does this form look suspicious? Report