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When you attend an Oregon EMS Association class that is supported by a grant, the grant funder can require us to request additional information from students. Please complete the following form to allow us to continue providing low-cost, grant supported courses to Oregon EMS providers.

Confirm this statement to establish eligibility for the grant-supported course fee. Anyone making a false statement will be expected to reimburse OEMSA the full course cost up to $375 & will not be allowed to attend any future OEMSA courses.
Name of attendee's agency affiliation where rural EMS duties are performed. If not with an agency, type "Unaffiliated." If you are a student, type the school you are attending.
Enroll in NAEMT online course roster prior to class day. This link is provided in your welcome email to fill in the online NAEMT enrollment form. That is how the PHTLS certificate will be generated. The form requires your State EMS license or NREMT certification number so attendees receive CAPCE credit.