NAFP Membership
Application Type New Membership
Renewal Membership
Name:
Email Address:
Street Address
City
State/Province
Zip Code
Country
Phone Number
This is my: Home number
Work number
Mobile/Cell number
Other
Alternative phone number (optional)
This is my: Home number
Work number
Mobile/Cell number
Other
Current Provider Level (Please check all that apply) Paramedic
EMT-I
EMT-B
Firefighter
RN
PA-C
Physician
Other
Current Certifications Held (Please check all that apply) None
NREMT-B
NREMT-I
NREMT-P
Paramedic Specialist (Iowa only)
ABLS Provider
ABLS Instructor
ACLS Provider
ACLS Instructor
ACLS EP
ACLS EP-Instructor
AMLS Provider
AMLS Instructor
AMLS Affiliate Faculty
BLS Provider
BLS Instructor
BTLS Provider
BTLS Instructor
Critical Care Paramedic
Instructor Coordinator (I/C)
NRP Provider
NRP Instructor
PALS Provider
PALS Instructor
PEPP Provider
PEPP Instructor
PHTLS Provider
PHTLS Instructor
PHTLS Affiliate Faculty
PPC Provider
PPC Instructor
PPC Affiliate Faculty
Training Officer I
Training Officer II
Other certifications not listed above:
College Degrees Held N/A
AAS
AS
AA
Bachelors
Masters
Doctorate/Ph.D
Degree Major
Employer/Service Name
Years of EMS Experience 0-1
2-5
6-9
10-13
14+
Brief Education/Work History (optional)

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