Please complete the form below to register for the Blades 24 HR EMT Refresher Class to be held on 1/3/15, 1/4/15, 1/10/15:

      CLASS TO BE HELD AT BLADES FIRE COMPANY, STATION 71, 200 E. 5TH STREET, SEAFORD, DE,  19973 

1/3      SATURDAY       0800 -- 1700 HRS

1/4      SUNDAY           0800 -- 1700 HRS

1/10    SATURDAY      0800 -- 1700 HRS.

Cost for class is $100 and payment is due at time of registration. Acceptable forms of payment are cash, money order, business check, Visa, MasterCard or Discover.  Please call (302) 223-5315 for payment arrangements.

If you select Bill Fire Company/Employer and your Fire Company/Employer denies authorization/payment you will be financially responsible for payment. 

FIRST NAME	*
LAST NAME	*
PAYMENT METHOD	*	BILL FIRE COMPANY BILL EMPLOYER SELF-PAY
AFFILIATION/EMPLOYER	*
APPROVING INDIVIDUAL	*
EMAIL	*
PHONE NUMBER	*
MAILING ADDRESS	*
CITY	*
STATE
ZIP CODE
SELECT COURSE		Blades January 2015 24 HR EMT Refresher
Security Code	*
COMMENTS/NOTES