First Name *
Initial *
Last Name *
Box/Street *
City *
Province MB SK AB BC ON QC NS NB NL PE NT NU YT *
Postal Code *
Home Phone Number
Cell Phone Number
E-mail Address *
Repeat E-mail
Gender Male Female *
Birthdate *
Manitoba EMS Provider Number *
License Expiry Date *
Provincial Training Level Please select your current training level Technician Technician Paramedic Technician Advanced Care Paramedic Student Other *
Current Service Affiliations
Current RHA Affiliation Please choose most appropriate affiliation Assiniboine Brandon Burntwood Central Churchill Interlake Nor-man North Eastman Parkland RHAM South Eastman Winnipeg Other *
Year Started in EMS *
Also note that if you wish to access the online con-ed testing you will alsoneed to fill out the form found here: http://www.paramedicsofmanitoba.ca/index.php/con-ed/con-ed-application
Paramedic Association of Manitoba2nd Floor, 1111 Portage AveWinnipeg, MBR3G 0S8
Phone: (204) 775-8482Toll Free: (866) 726-1210Fax: (866) 222-6471