Burke County Emergency Services
Training Division Registration Form
Please complete the following registration form to reserve your seat in the selected course. You will receive an e-mail confirming your registration.
Course To Be Taken
Injury Simulation March 26th and 27th
Last Name
First Name
Middle Initial
Address
City
State
Zip
Agency Affiliation (example: Burke County EMS)
Home Phone
Work Phone
E-Mail Address
Receive Mass Email?
I agree to receive an e-mail confirmation and additional information for the course I have registered for. No SPAM will be sent to this address from Burke County Emergency Services.
For additional information, contact the Training Division at 828/ 430-4213.