Please complete the form below to register for the Bridgeville 24 HR EMT Refresher Class to be held on 2/1/2015, 2/8/2015, 2/15/2015      CLASS TO BE HELD AT Bridgeville Fire Company, Station 72, 311 Market Street, Bridgeville, DE  19933 

2/1     SUNDAY       0800 -- 1700 HRS

2/8     SUNDAY       0800 -- 1700 HRS

2/15    SUNDAY      0800 -- 1700 HRS.

Cost for class is $125 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		Bridgeville 2015 24 HR EMT Refresher
Security Code	*
COMMENTS/NOTES