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2009 Courses Student Registration

If Applicable

Name: Address:

EMT Level:
If Applicable

EMT Number:

State:

City/Town: Phone: Email: Department or Agency: Address: City/Town: Phone: Rope Rescue (Awareness) $125 Confined Space (Awareness) $125 Fall Protection $65 Rope Access (Clinics) $ Fress Cell:

Zip:

Country:

Zip: Supervisor:

Country:

Rope Rescue (Operations) $210 Confined Space (Operations) $425 Multi-Gas Meter (Use & Operations) $ 90 Price Total: $ Deposit:

Payment Methods: Payment is accepted by Cash, Check, Money Order, Visa, Master Card, or Department PO. All Checks and Money Orders must be payable to IEME 3 weeks prior to the class. Cash Check # Visa Mastercard PO Name : Card #: Exp. Date CV Code:

Mail to : IEME International, Inc 24 Briggs Ave. Bourne, MA 02532 USA
Questions: Contact Scott Bumpus, FF/EMT-P Training Coordinator @ (339) 502-5050 ext 303 Email: sbumpus@iemeinternational.com

*Rope Rescue & Confined Space Operations classes only
In order to be able to attend these programs, the student must show proof of entry level Rope Training or have had Rope Access (Awareness) or Rope Rescue I prior to this Class. All applicants must provide verifiable proof of ID at start of the class and sign all Liability wavers. Students with disabilities will not be rejected. Our efforts will be made to assist those with difficulties as the need arises.