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Arkansas emt patch order form 2026

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The document is an order form for Arkansas Certified Emergency Medical Technicians (EMTs) to purchase various patches and rockers, including EMT patches, paramedic rockers, and identification cards. It outlines the items available, their costs, and instructions for payment. Only certified Arkansas EMTs are eligible to order these items.

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Click ‘Get Form’ to open the Arkansas EMT Patch Order Form in our editor.
Begin by filling in your personal information. In the 'NAME' section, enter your last name, first name, and middle initial as required.
Next, provide your complete 'ADDRESS', including street address, city, state, and ZIP code. Ensure all details are accurate for proper delivery.
In the 'COUNTY' field, specify your county of residence. This is important for eligibility verification.
Select the items you wish to order by indicating the 'QUANTITY' next to each patch or rocker type. Remember that only certified Arkansas EMTs may order these items.
Calculate the total amount due based on the quantities selected and write it in the 'TOTAL ENCLOSED' section.
Finally, send a certified check or money order to the specified address of the Arkansas Department of Health.

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