Armington EMT-B Enrollment Form

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This form needs to be completely filled out. Any questions about enrollment can be directed to McLean County Area EMS System at 309-827-4348.

Your enrollment will not be considered complete until payment is received in full. Checks can be made out to: McLean County Area EMS System

Email *

First Name *

Last Name *

Phone Number *

Address *

City *

State *

Zip Code *

Email *

Agency (if applicable)

Date of Birth *

YYYY

Have you been convicted of a felony? *

Yes

Have you ever been licensed as a medical responder? *

Yes

Have you ever had your medical responder license suspended? *

Yes

N/A

Drivers License Number or State ID Number *

Do you have a high school diploma or GED *

Yes

Will graduate by May of 2020

A copy of your responses will be emailed to the address you provided.

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