EMT-Tactical® Course Registration

Complete the registration form below to apply for an upcoming EMT-Tactical® course.

Registration is subject to prerequisite review, seat availability, and payment or approved billing arrangements.

Payment note:Self-pay students will submit a non-refundable $50 registration fee through this form. This fee will be credited toward the total EMT-Tactical® course tuition. VA, agency-pay, and contract-billing registrations will be reviewed by RTI for approval and follow-up.

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Course Applying For *

Registration Acknowledgment *

I understand that I am registering for the EMT-Tactical® course selected above and that registration is subject to seat availability, prerequisite review, and payment or approved agency billing arrangements.

Prerequisite Confirmation *

I confirm that I have medical training to at least the EMT level or equivalent and am affiliated with, employed by, or serve a public safety, military, law enforcement, fire, EMS, or related agency.

Legal Name *

First

Middle

Last

Preferred Name / Name You Go By

Age

Current age

Date of Birth *

Email Address *

Cell Phone *

Mailing Address *

Address Line 1

Address Line 2

City

State

Zip Code

Current Medical Certification / License Level *

State of Certification / Licensure *

Enter certification or license number

Expiration Date

Years of EMS / Medical Experience

Years of Tactical/SWAT Experience

Employer / Agency *

Employer Phone

Occupation / Current Position *

Agency Type / Public Safety Employment *

EMS
Police / Law Enforcement
Fire
Military
Homeland Security
Federal Agency
State Agency
Local Government
Other Public Safety

Supervisor Name

Supervisor Phone

Currently providing tactical medic support?

Tactical Team / Agency Supported

Emergency Contact Name *

Relationship to Student

Emergency Contact Phone *

Emergency Contact Alternate Number

Medical Care Acknowledgement *

I understand that I am financially responsible for any and all medical care rendered to me in the event of an emergency while attending the course.

Lockport Payment Information

Please select the payment type for this registration.

Payment Type *

Self-Pay
VA / Veteran Benefits
Agency Pay

Agency Pay:

If an agency, department, or organization will be paying for this registration, RTI will follow up regarding invoice, purchase order, or approved agency billing arrangements.

Agency Pay Acknowledgment *

I understand that selecting Agency Pay does not guarantee, reserve, or hold a course seat. I understand that my seat is confirmed only after approved agency billing, purchase order, invoice, or payment arrangements have been completed by RTI.

EMT-Tactical® Self-Pay Registration Fee *

Price: $50.00

This non-refundable $50 registration fee is credited toward the total EMT-Tactical® Lockport course tuition of $1,299.00 when tuition is paid.

Application Fee Acknowledgment *

I understand that the $50 application processing fee is non-refundable and is required before my application will be processed.

Stripe Credit Card *

Billing Agency / Organization *

Agency Billing Contact Name *

Agency Billing Contact Email

Agency Billing Contact Phone

Agency Billing Notes

VA / Veteran Benefits:

Students using VA or veteran education benefits must provide a current Certificate of Eligibility before a course seat can be confirmed. Submission of this registration form does not guarantee, reserve, or hold a seat until VA eligibility documentation and RTI approval are complete.

Date Certification of

Certificate of Eligibility Upload

Drag & Drop Files, Choose Files to Upload

Please upload a clear copy of your Certificate of Eligibility. This document is required before we can submit for your VA education benefits. PDF, JPG, or PNG files are preferred. Maximum file size: 2 MB.

VA Documentation Acknowledgment *

I understand that a current Certificate of Eligibility is required before my seat can be confirmed. I understand that submitting this registration form does not guarantee, reserve, or hold a course seat until required VA documentation and RTI approval are complete.

Lockport Payment Acknowledgment *

I understand that the $50.00 registration fee is non-refundable, will be credited toward the total EMT-Tactical® tuition of $1,299.00, and does not guarantee, reserve, or hold a course seat. I understand that my seat is confirmed only after full tuition payment is completed. If the course fills before full payment is completed, the $50 registration fee remains non-refundable.

Attestation *

I certify that the information submitted is true and accurate to the best of my knowledge.
I understand that any intentional misrepresentation or false information may result in denial of course registration, denial of course completion documentation, or removal from the course.

Electronic Signature *

By typing my name above, I agree to the use of my typed name as my electronic signature for this EMT-Tactical® course registration. I certify that the information submitted is true and accurate to the best of my knowledge and understand that this electronic signature has the same effect as my handwritten signature.