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EMS Education Course Enrollment

Please make your selection for the courses below and fill out the entire form before clicking submit. If you have any questions, please call the Genesys EMS Education department at (810) 606-7763.

  • All registration forms must be received one-week prior to the session date
  • Sessions must be paid in advance by credit card.
  • Cancellations require a three-day notice        
Classes currently available:




















PERSONAL INFORMATION: Please complete the form below. The information you are about to submit is secure. (Bolded fields are required.)

Name:
Street Address:
City:
State:
Postal Code:
E-mail Address:
Telephone #:
Liscense Number (if applicable)
Liscense expiration date (if applicable)
Level of liscensure (if applicable)
PALS registrants, please complete these fields;
Manager name
Manager phone number
 
CARDHOLDER INFORMATION:
Name:
Street Address:
City:
State:
Postal Code:
Credit Card Number:
Expiration Date:Card Type
/
Security code: (on back of card)


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