2010-2011 Registration Form
2010 Class
Requested
Nov 2010 Diver Medical Technician
Tuition
$1350.00
2010 Emergency Medical
Technician
Tuition $650.00
2011 Class Requested
April 2011 Diver Medical Technician
Tuition $1350.00
Oct-Nov 2011 Diver Medical Technician
Tuition $1350.00
Please Note: Changes in DMT curriculum requirements as of January 1,
2010 by the NBDHMT require that an "Advanced Skills" class be
incorporated into the DMT class.
Student Information
First
Name
Last Name
Address 1
Address 2
City
State
/ Province
Country
Postal /
Zip Code
Telephone
e-mail
Medical Background
Choose One
Explain Other
Diving
Background
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Certifying Agency
Payment (Note: Payment is not immediately required)
Choose One
Message or Additional Comments