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How to use or fill out PDF EMS Certificate/Wallet Card Replacement Form

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Click ‘Get Form’ to open it in the editor.
Begin with Section 1 – Personnel Data. Fill in your last name, first name, and middle name. Ensure you type or print in black ink for clarity.
Select your EMS role from the options provided, such as EMT or Licensed Paramedic. If applicable, indicate if you are enclosing a $10 fee.
Complete your contact information including address, city, county, state, zip code, telephone number, and email address.
If claiming fee exemption, proceed to Section 2 – Volunteer Sign-Off. Have an approved EMS Provider or FRO administrator complete this section.
In Section 3 – Signature and Date, affirm that all information is accurate by signing and dating the form.

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Versions	Form popularity	Fillable & printable
2021	4.8 Satisfied (187 Votes)
2017	4.4 Satisfied (237 Votes)

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