Online Registration Name * First Name Last Name Email * Phone * (###) ### #### Mailing Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Which course/program are you registering for? * AEMT BLS/CPR ACLS PALS PHTLS AMLS EMS Safety All-Hazards Disaster Response EMT Instructor Course (MOI/ASO) What is your current certification level? * None ETT AK-EMT AK-EMT2 AK-EMT3 NREMT NRAEMT (not AK) AKAEMT What region do you currently live or work in? * South Central Alaska Southeast Alaska YKHC Interior Alaska North Slope Borough Northwest Arctic/Maniilaq Norton Sound Non Alaskan/Out of state How will you pay for the course? * Credit/Debit card Check by mail Tuition Assistance Employer check If you answered "Tuition Assistance" above, select your scholarship N/A MatSu Health Foundation Regional Council Scholarship Other Other Scholarship Information How did you hear about us? Instagram Facebook Search engine (Google, Safari, etc) Word of mouth Thank you! We have received your registration. You will receive an email soon with steps to proceed.