EMT Online Course Please fill out the form below. You will receive an email with your free information packet! We will call you within one week of filling out this form. You can reach our EMS Academy Enrollment team at 281-416-5939. * Email Address: * First Name: * Last Name: * Phone: * Highschool Diploma/GED: - please select - YES NO * Please specify your highschool diploma/ged: How did you hear about us?: - please select - Google Yahoo The Buzz Twitter Facebook YouTube Other * State: - please select - Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming * City: Address: * ZIP: Comments: Payment required for registration to selected course.