On-Line Registration

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Nasal Narcan Administration(2319ELRN59)

Description:

This is an online program used for Continuing Education credit.

Price: $0.00

Start Time: 10:00
End Time: 10:00

Start Date: July 2, 2018
End Date: July 1, 2019

Address:

NH Fire Academy
98 Smokey Bear Blvd
Concord, NH
03301
Map and Directions

Registration Details

Personal Information

First Name*

Middle inital

Last Name*

Email*

Additional Personal Information

Last 4 of SS#

Date of Birth*

Mailing Address*

City*

State*

Zip*

General Admission Information

Fed Student ID Number: If you do not have one please click here to receive one.

Sex*

Home Phone

Work Phone

Cell Phone

Cell Phone Provider (if you wish to get text message course confirmations.) (Standard text rates apply)

Preferred Method of Contact*

Email/Text
Mail

Full Department/Agency Affiliation Name*

Department/Agency Address, City State & Zip

Department/Agency Phone #

Department/Agency Fax #

Indicate your Affiliation

US Citizen*

If NO, please indicate country of birth

I certify that the information on this application is correct and understand that falsification of information may result in denial of a course certificate. I understand and agree to abide by the rules, policies, and refund policy of the NH Division of Fire Standards and Training & Emergency Medical Services (NHFSTEMS). I hereby authorize release of any and all information concerning my enrollment in this course to the chief officer in charge or designee of my organization. Unless I am employed by the State of NH, I understand and accept the fact that I am not covered by any insurance provided by the State of NH, the Fire Standards and Training Commission, or any other instructor nor will insurance from any of these agencies be available in the event of my injury or death.*

Please Type your name to Attest to the Statement*

Date that you Attest to the Statement*

On-Line Registration

Nasal Narcan Administration(2319ELRN59)

Registration Details

Personal Information

Additional Personal Information

General Admission Information

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