Course Name: Emergency Medical Responder (PILOT)
Log Number: EMS-105-S013-2023
Class Start Date & Time: 03-06-2023 at 19:00
Class Location: Howard County DFRS Training Academy


This course has prerequisites. You must provide proof that you have met all prerequisites to the MFRI NCRTC Office sponsoring this course.
Prerequisites: There are no prerequisites for this course.

Please use complete legal name as shown on your photo identification.
Example: Joseph Jay Smith
Enter date in format: MM/DD/YYYY or select with pop-up calendar.
Example: 07/20/1969
Example: 123-45-6789
SID Number available from NFA at:cdp.dhs.gov/femasid/register
If you have forgotten your NFA SID you can find it at:cdp.dhs.gov/femasid/account/find
Example: 8811 60th Avenue

Example: College Park
Example: MD
Example: 20742
Example: US
Example: info@mfri.org
Example: 301-226-9900

If your agency is not listed in the list above and you do not work for a commercial ambulance service, please select "Unaffiliated". If you have any questions about the registration process please contact the MFRI NCRTC regional office. Contact information can be found at: https://www.mfri.org/ncro
Registration for this course requires that you have completed a profile with MIEMSS. This profile can be completed online on the MIEMSS website. Access the website to create your profile at: www.miemsslicense.com
You must complete your profile before the start date for this course.

RELEASE STATEMENT:

In compliance with the federal Family Educational and Rights to Privacy Act of 1974 and the Buckley Amendment, by checking the box below I authorize and give my permission to the University of Maryland, Maryland Fire and Rescue Institute, and the Maryland Institute for Emergency Medical Services Systems to release information concerning my training records to:

  1. the primary instructor of this course;
  2. the local training academy, if this course is being conducted within, or in collaboration with, such academy;
  3. and / or any federal or state agency (Maryland or other) with authority to certify, regulate, and/or fund EMS programs and personnel;

MFRI Course Acknowledgement Statement:

  1. I acknowledge that any fraudulent entry may be considered sufficient cause for rejection or subsequent revocation from this course.
  2. I understand the University of Maryland is not authorized to provide travel, medical, or health insurance for students. I maintain appropriate insurance on an individual basis. I will check my department's insurance policy to determine if I am sufficiently and appropriately covered.
  3. I understand that this registration is not to be regarded as an irrevocable contract between the student and the University of Maryland.
  4. I affirm and declare that I am physically and mentally fit to perform all tasks within this course.
Check box to acknowledge that you have read the statements above.

MFRI Operations Rules and Regulations:

You are required to read the MFRI Operations Section Rules and Regulations and then check the box.


Check box to acknowledge that you have read the MFRI Operations Section Rules and Regulations

Resources to be Issued to Student:

  • Emergency Medical Responder: Your First Response in Emergency Care, 7th edition, January 2022 edition Price: \$123.21
  • Samsung Galaxy Tablet, February 2019 edition Price: \$200.00

Please check the box to acknowledge that you understand that you are responsible to either return any books or other resources provided by MFRI for this course in usable condition or to pay for those materials. If you have not returned the materials or paid for them at the completion of this course, you will not receive your grades or credit for this course. Even if your sponsoring agency has agreed to pay for your materials, you may be held responsible for payment.


By checking this box I acknowledge that I will pay for any books and resources provided to me by MFRI or return them in usable condition at the end of the course.
By checking this box I give permission for MFRI to provide my contact information with the Maryland State Firemen's Association so they can provide me with information about benefits that are available to me.

If you do not check the box above your information will not be shared with the Maryland State Firemen's Association. To learn more about the benefits that are available to you from the Maryland State Firemen's Association visit their web site at: www.marylandvolunteer.org