Application Form

							Name
						
							Email
						
							Message
						
							Resume Upload
						
							Position
						
							NREMT #
						
							NREMT Expiration
						
							EMSRB #
						
							EMSRB Expiration
						
							WI License #
						
							WI Licence Expiration
						
							CPR Card Issue Date
						
							CPR Card Expiration
						
							ACLS Issue Date
						
							ACLS Expiration
						
							PALS Issue Date
						
							PALS Expiration

Lakes Region EMS
40245 Fletcher Ave
North Branch, Minnesota 55056

651-277-4911 Operations / Billing / Education
651-674-4628 FAX
651-224-8994 Interfacility Transfer