RN/RT to EMT Class (April 2023)
Instructions:  Please complete this form to begin your registration for the RN/RT to EMT Class. You must also contact BRTC Corporate & Community Education to complete your registration and submit payment at 870-248-4180. (Registration is not complete until payment of $600 is received in full.) 
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Email *
First Name *
Middle Name *
Last Name *
Mailing Address  
(Example: 1234 Test Way)
 *
Mailing Address 
(Example: Pocahontas, AR 72455)
 *
Date of Birth *
MM
/
DD
/
YYYY
Sex: *
Phone Number (Ex: (555-555-5555) *
Email Address *
If job related: Employer Name & Employer Address
How did you hear about this class? *
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