EMT-Tactical Registration Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form. – Step 1 of 2Course Applying For *— Select Choice —EMT-Tactical® — Lockport, NY — September 22–25, 2026Registration 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 *FirstMiddleLastPreferred Name / Name You Go ByAgeCurrent ageDate of Birth *Email Address *Cell Phone *Mailing Address *Address Line 1Address Line 2City— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeNextCurrent Medical Certification / License Level *— Select Choice —EMTAEMTParamedicRNMD/DOMilitary Medic / ATP/ CorpsmanOtherState of Certification / Licensure *— Select Choice —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingNational RegistryMilitaryOtherEnter certification or license numberExpiration DateYears of EMS / Medical ExperienceYears of Tactical/SWAT ExperienceEmployer / Agency *Employer PhoneOccupation / Current Position *Agency Type / Public Safety Employment *EMSPolice / Law EnforcementFireMilitaryHomeland SecurityFederal AgencyState AgencyLocal GovernmentOther Public SafetySupervisor NameSupervisor PhoneCurrently providing tactical medic support?YESNOTactical Team / Agency SupportedEmergency Contact Name *Relationship to StudentEmergency Contact Phone *Emergency Contact Alternate NumberMedical 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 InformationPlease select the payment type for this registration.Payment Type *Self-PayVA / Veteran BenefitsAgency PayAgency 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: $50.00This 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 EmailAgency Billing Contact PhoneAgency Billing NotesVA / 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. 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. Supported / Occupation Submit
