EMRS Registration Page

Please complete the following form to be considered for access to the Medical First Response program. Once you click the Register button, your request will be forwarded to The EMRS Project Manager who will activate your account.

Date:

Radio Number:

Name:

Desired User Name:

Company Or Department:

Desired Password:

Address

 

 

City:

EMS Station:

State:

 

 

Zip:

Education Level:

Home Telephone:

Cell Telephone:

Pager Telephone:

Other Telephone:

E-Mail Address:

 

 

Social Security Number:

Date Of Birth:

Drivers Licence Number:

Drivers Licence State:

Certification Level:

Certification Expires:

       
     
     

 

 


Catawba County Home PageContact EMRS Project Manager