Individual Registration

Please enter information in the form below to process registration for event Ice Rescue EMS Objectives 2025.

First Name *

Last Name *

Organization *

Address *

Address 2

City *

State *

Zip *

Phone *

Email *

Chief Officer *

Payment is due on or before the start of the class. Checks/Vouchers/Purchase orders should be made out to Bayport FD Engine Co. 1. Any items purchased from Lifeguard Systems, including the throwbag should be paid by Check or Credit card to LGS at the class.

Are you a member of Community Ambulance? *

Yes

Payment Information

Amount

Payment Method

Offline Payment

Credit Card Number*

Expiration Date*

Card (CVV) Code*

Card Holder Name*

By registering for this event, I accept Terms and Conditions