EVOC Instructor Course - Birmingham Regional EMS System

Course Approval

EVOC Instructor Course Date - Day 1

For Admin Use Only

EVOC Instructor Course Date - Day 2

Contact information

First name *

Last name *

Email *

Confirm the previous field *

Mobile Phone *

Street Address *

City *

State *

Zip Code *

Course Completion Requirements

BREMSS Course Completion Requirements *

I acknowledge that this course records both time and participation level which in conjunction with the final assessment score determines success of this course. I forfeit any opportunity for remediation should a failure on my part be a direct result of not meeting the minimum participation percentage. By cchecking this box and completing the course registration process, I agree with the completion requirements set forth by BREMSS.

Invoice information

Invoice my agency

Invoice - Company name

Invoice - Street

Invoice - Post box

Invoice - City

Invoice - State

Invoice - Zip code

EMSP Information

License State *

Provider Level *

EMSP License # *

NREMT Certification # *

i.e. E1234567, begins with either E, A, or M. If not certified enter N/A

EMS Region *

County *

Agency *

Other Agency

Complete if 'other' was selected above

Registration summary

Items

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Important information

All self-paced, online course work must be completed prior to the lecture session.

** Refunds and Cancellations**

Should the course not meet minimum enrollment policy by the date 10 days prior to the course, the decision will be made as to whether the course will be conducted. If and when the course meets the minimum course enrollment guidelines, notification will be sent at that point.
- In the event that the course in which you are enrolled does not meet the required attendance policy, you will be given the option to move your registration to a future course with availability or have your tuition refunded in full.
Refunds for the EVOC Instructor Course, other than cancellation of the course by the host institution, are subject to the Institution's refund policy. Participants who wish to cancel their enrollment must notify the Institution in writing.
- If reimbursement is requested, there will be a 5% deduction for processing costs.
- No registration fee will be returned if cancellation occurs within two weeks of the course.

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Instructor Candidate Lecture Topics

Driving Course Exercises

BREMSS EMS Personnel

Contact information

Company Information

Course Completion Requirements

Invoice information

EMSP Information

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