CMH EMS Education Application Form
The permanent link to this form is http://ozarksems.com/education-application.php

A lot of good info can be found on our website to answer your questions about EMS classes at CMH. Or you can email theron.becker@citizensmemorial.com
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Student vaccination requirements:
Please refer to https://ozarksems.com/edman-2-600-66.php for flu shot and COVID vaccination requirements for students.
Your first name: *
Your last name: *
Your email address (this is our primary means of communicating with students): *
Agency you belong to (not required but helpful):
Your cell phone number with text messaging (this is our secondary means of communicating with students) [optional]:
Which course are you enrolling in? *
If you pick "Other - Not Listed," above, what is the name of the course?
What is the start date of the course? *
MM
/
DD
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YYYY
What is the start time of the course? *
Time
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