Print Form

This form is to be used for all training that is completed outside of BLS OTEP on emsonline.net.  There are two options for using this roster.  Either download it, print it out, fill it out, and fax it to the Regional Training Coordinator at 360-479-5772.  Or, download the document, save it to your computer, fill it out electronically and hit send.. to email it to the Regional Training Coordinator at admin@nwrems.org.

Form

Online Form

What is the name of the course?

Airway CPR First Aid (Other) Other:

 

 

 

Name of the Instructor of the course?

Where was the course located?

Please list course date:

Please list start time and end time:

AM PM

AM PM

 

Please list the name of all of the attendees:

Name and Contact Information of person submitting the form:

Name
E-mail
Tel
FAX

Please contact me as soon as possible regarding this matter.