Prehospital RN

Registration Form

Sarah Bush Lincoln
EMS Department
104 Professional Plaza
Mattoon, IL 61938
emsgroup@sblhs.org
217-258-2403

* indicates a required field.

Date: *

Name: *

Address: *

City: *

State: *

Zip: *

Phone number: *

Email: *

Course Type:

Initial Provider

Recertification

Agency Affiliation: *

EMS Provider Level: *

Basic - (EMD, EMR, EMT-B)

Advanced - (Paramedic, PHRN, RN, Physician)

Other

Course Date:

June 3, 10, 17, 24, July 8, 15, 22, 29, 2024 - 8 am - 4 pm

Comments:

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