PDREMS, Inc.

Follow us

Call Today!

1314 W. Darlington Street
Florence, SC 29501
843-662-5771 (call)
843-662-9444 (fax)

Course Registration Form

NAME (First Middle Last)
PHONE
EMAIL
ADDRESS
CERTIFICATION NUMBER (N/A IF REGISTERING FOR EMT)
DATE OF BIRTH
LAST 4 OF SSN#
CITY, STATE, ZIP
COURSE YOU ARE REGISTERING FOR
COMMENTS
Students Registering for EMT, AEMT, or Paramedic Courses must provide Polo Shirt Size
Submit