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Northwest Rural

Emergency Medical Services Association

Harris County Emergency Service District 8

CPR Course Registration Form

To register for a class, please print the CPR Registration Form and mail it to Northwest EMS along with your payment. A confirmation letter will be sent back to you by your choice of mail, fax or email and this letter must be brought with you to class. Registration forms need to be received by Northwest EMS at least 1 week prior to class. Tomball Fire Department may pay for your class, if you live inside the city limits of Tomball. You must still fill out the registration form and mail it along with payment to Northwest EMS one week prior to the class; your prepayment will be considered a deposit. Reimbursement will be given to City of Tomball residents the day of the course. For details, please contact Tomball Fire Department at (281) 351-7101. Since this is a gift and not our obligation, we reserve the right to deny any fee reimbursement.

Date of Course Name Address Apt/Room # City Phone # Amount enclosed $ Check # State Zip

Please send my conformation number by:

My Email address is: My Fax Number is: My Mailing address is:

Signature________________________________ Date____________________

After completing press here to print form, sign and return to NWEMS.

P.O. Box 696 Tomball, Texas 77377-0696 Business Office 281.351.8269 Business Fax 281.357.4524

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