Prehospital Care Program Registration Form

Complete the form below to register for UPMC's Prehospital Care classes.

First Name Last Name Email Address Date of Birth Primary Phone Mobile Phone Street Address Street Address 2 City County State Zip Code Provider Certification Number Your Certification Level (Check all that apply) EMR EMT AEMT Paramedic PHRN PHP/ PHPE Other Are you under UPMC or CMC Medical Command Authorization? Yes No For what EMS service do you provide care? Class Title Class Title (if other) Date of Class Indicate the timeslot of the class (if applicable)

I understand that by providing my email address, I agree to receive emails from UPMC. I understand that I may opt out of receiving such communications at any time.

​Prehospital Care Program Registration Form

Prehospital Care Program Registration Form