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NREMT Certification Information
Parent Information
Academic
Additional Information
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First Name
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Last Name
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Email Address
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Date of Birth
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What is your current NREMT status?
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-- choose one --
Currently NREMT Certified
Expired NREMT Certification
Not Yet Certified
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Street 1
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Street 2
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City
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State
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ALABAMA
ALASKA
AMERICAN EMBASSY
AMERICAN SAMOA
ARIZONA
ARKANSAS
ARMED FORCES THE PACIFIC
CALIFORNIA
COLORADO
CONNECTICUT
DELAWARE
DISTRICT OF COLUMBIA
FLORIDA
GEORGIA
GUAM
HAWAII
IDAHO
ILLINOIS
INDIANA
IOWA
KANSAS
KENTUCKY
LOUISIANA
MAINE
MARYLAND
MASSACHUSETTS
MICHIGAN
MINNESOTA
MISSISSIPPI
MISSOURI
MONTANA
NEBRASKA
NEVADA
NEW HAMPSHIRE
NEW JERSEY
NEW MEXICO
NEW YORK
NORTH CAROLINA
NORTH DAKOTA
OHIO
OKLAHOMA
OREGON
PENNSYLVANIA
PUERTO RICO
RHODE ISLAND
SOUTH CAROLINA
SOUTH DAKOTA
TENNESSEE
TEXAS
UTAH
VERMONT
VIRGIN ISLANDS
VIRGINIA
WASHINGTON
WEST VIRGINIA
WISCONSIN
WYOMING
Zip Code
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Zip Code Extension
Postal Code
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US Cell Phone
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US Cell Phone Area Code
US Cell Phone Exchange
US Cell Phone Number
US Cell Phone Extension
Ext:
is Required
is Required
is Required
NREMT Expiration Date (Select only one)
Required
3/2022
3/2021
3/2020
What is your NREMT Certification Number?
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NREMT Certification Level (Select only one)
Required
EMR
EMT
Paramedic