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August 2013 EMT-I to AEMT Bridge Course

Please complete the form below to register for the EMT-I to AEMT Bridge Course. This information is entered into the State of Georgia’s Office of EMS database for tracking students and issuing initial and renewal EMS license.

All information collected is secure and only available to the training academy and the State Office of EMS.

This information must be entered by Wednesday August 7th at 16:00.

After you complete the information below, Tom Kamplain will be in contact with you complete the process.

Please contact Tom Kamplain with any questions at or by phone at 770-315-6422 Monday – Friday from 9am – 8pm.

First Name (required)

Last Name (required)

Email Address (required)

Phone Number (required)

Street Address (required)

City (required)

State (required)

Zip Code (required)

Date of Birth (required)

Social Security Number (required)

Emergency Contact Name (required)

Emergency Contact Phone Number (required)

Georgia Institute of EMS