LLUMC Prehospital Care - Class Registration

Fire truck, ambulance, helicopter

Prehospital registration form:

Course name: * 
Preferred course date: * (mm/dd/yyyy)
If renewal, expiration date of current card : (mm/dd/yyyy)
First name: * 
Last name: * 
Employer: 
Occupation: *EMT Paramedic Nurse Physician Clerical Administrative Other
Professional license number: (Enter N/A if not applicable) * 
Street address: * 
City: * 
State: *Choose a state Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Neveda New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington, DC West Virginia Wisconsin Wyoming
Zip: * 
Daytime phone:  
Evening phone:  
Other phone: Cell Pager Voicemail Other
Email: * 
* Indicates required fields

Address:
Center for Prehospital Care, Education and Research
11234 Anderson St., Room A234,
P.O. Box 2000,
Loma Linda, CA 92354
Phone: (909) 558.7611
Fax: (909) 558.7934
Email: ems@lluems.com

 

  • Submitting registration form does not guarantee a spot in the course.
  • We will not confirm registration forms that do not have all required fields completed.
  • We reserve the right to cancel classes at any time.