Print this registration form, complete it and return it with payment to:
    AMR
    Attn:  Course Registration
    517 S. Division
    Grand Rapids MI 49503

Name:                                                    License Level:                               
Address:                                                                                                        
City:                                                        State:                    Zip Code:            
Home Phone:                                            Work Phone:                                    
Employer:                                                                                                        
E-mail:                                                                                                            

#1 Course Name:                                            Recert or Provider   Course Date:                    
    Textbook needed?                                    Amount Enclosed:                                

#2 Course Name:                                            Recert or Provider   Course Date:                    
    Textbook needed?                                    Amount Enclosed:                                

                       [   ]  I will download my pre-course material from the internet
                                                    www.ems-education.com

                       [   ]  Please send my pre-course material via US Mail

This page was last modified on:  01/24/2008