Please complete the form below to register for the Laurel Fire Company 24 HR EMT Refresher Class.  

CLASS TO BE HELD AT LAUREL FIRE COMPANY 205 WEST 10TH STREET, LAUREL, DE  19956  Class schedule is:

DAY 1           HYBRID MUST BE COMPLETED BEFORE DAY 2

ENTRANCE TO DAY 2 WILL NOT BE PERMITTED IF HYBRID IS NOT COMPLETED

DAY 2           Saturday   12/6   0800 -- 1700

DAY 3           Sunday      12/7  0800 -- 1700 

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		Laurel Fire Department -- Day 1 HYBRID, Daye 2 -12/6, Day 3 - 12/7
Security Code	*
COMMENTS/NOTES