Please complete the form below to register for the Hartly 24 HR EMT Refresher Class. 

CLASS TO BE HELD AT HARTLY FIRE COMPANY, STATION 51, 2898 ARTHURSVILLE ROAD, HARTLY DE, 19953. 

Cost for class is $99 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		Hartly 24 hour Refresher
Security Code	*
COMMENTS/NOTES