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Get EMT Basic Application

Eceived City on State Application Date B Date (MM/DD/YY) Social Security Number Fee Number Written Exam Date Have you ever applied for NREMT-B registration? If you possess current state certification as an EMT, please list your current state EMT Current EMT Number Please attach copy of card certification number in the space provided and attach a copy of your current EMT card Last Name First Name Mailing Address Yes No MI Program Code Gender City St.

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