1Student Information

2Certification Info

3Agreement & Payment

Student Information
Full Name*
First Last
Email Address*
Please use your personal email address rather than a work or school account. Course instructions will be emailed to this address, and it will also become your username for logging into the online course.
Enter Email Confirm Email
Alternate Email Address
If you sometimes use another email address, like a work or school account, please enter it here.
Enter Email Confirm Email
Cell Phone Number*
Just in case we can't reach you by email.
Mailing Address*
Please note the state of New York does not accept our courses.

Street Address Address Line 2 City State ZIP Code

Certification Info
Course Name: EMR 16 Hour NCCP Refresher
Price:
Select type of recertification*
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Enter your national registry number
Log in to your NREMT account here to find your registry number. It is a letter followed by seven numbers (for example: A12345678). If you cannot find this number now, you will just need to send it to us before completing the course.
Select renewal State*
Please ensure your state accepts a CAPCE accredited 16 hour EMR recertification course. Contact us if you have questions.
Enter your State EMR certification/license number
If you do not have this number now, you just need to send it to us before finishing the course.
Expiration date of your state EMR certification/license*
Month
Day
Year
Are you a licensed Peace Officer?*
This course qualifies for POST credits.
POST license number
This field only applies if you are a licensed Peace Officer that would like to receive POST education credits for this course.
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Enter your 12 digit NREMT EMS ID
This is the new 12 digit number assigned to all NREMT-certified personnel also found within your NREMT account. If you cannot find this number now, you will just need to send it to us before completing the course.
Enter your 12 digit NREMT EMS ID
Don't know your EMS ID? You can skip this field and email it to us later after checking your NREMT account.
Expiration date of your NREMT certification*
You must complete recertification training before your expiration date.
Month
Day
Year
BLS Classroom Session*
A classroom session is required to practice and test out on your skills at our EDINA facility (7405 Bush Lake Road, 55439).
BLS Certification
The Minnesota EMS Board highly recommends EMRs maintain BLS certification (CPR for Healthcare Providers), and it's also required by most employers. We provide a BLS course for those who need it.
Anything else you'd like us to know?

Payment
Promo Code
Northwestern Health Verification*
- I verify that I am currently a student or faculty/staff member of Northwestern Health Sciences University.
Total
$0.00
Payment Method*
Credit Card*

American Express
Discover
MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number Expiration Date Security Code Cardholder Name
Invoice to a Sponsoring Organization
Did your organization give you a code to enter when registering?*
Organization ID Code*
Enter the code below
Name of Organization*
Contact Person at Organization*
First Last
Phone of Contact Person*
Email of Contact Person*
Mailing Address of Organization*
Street Address Address Line 2 City State ZIP Code
Instruction for Submitting Invoice
Enter any specific instructions we should know about submitting an invoice to this organization (for example: what to include in the memo, etc).
Invoice Terms and Conditions*
- I understand and agree that the organization above has authorized payment for my course fees.
Terms & Conditions
State Acceptance*
Please contact us if you aren't sure whether your state will accept this course.
- I verify that my state will accept this CAPCE-accredited refresher course.
Terms and Conditions*
- I understand and agree to the TERMS AND CONDITIONS
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Signature of Student
By typing my first and last name below, I verify understanding and agree to the terms and conditions. I also verify that the person completing this form is the student enrolling in the course.
First Last

EMR Recertification V2

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