EMT-Basic Practical Registration

SC Midlands EMS Management Association

3201 Leaphart Road

West Columbia SC 29169




Instructions for Basic Practical Testing



Cost for first time testing is $25.00 per station Total of $100.00


We do NOT accept personal checks – we do accept credit card payments, a money order or a cashiers check payable to Midlands EMS


Money is due in our office one week prior to exam.   Please make sure you have sufficient time for mail.  Students should not come by our office to pay.


The completed form below should accompany your testing fees.


You should arrive at this office on the morning of your test at 8:30am no later than 8:45.  You must present proper ID to the National Registry Representative

Students that are not checked in by orientation at 9:00am will not be allowed to test.


If unable to attend after payment is made please notify this office and we will move you to another date.


Please Print Clearly


Student Name______________________________Phone Number______________________


School Attended______________________________________Last 4 digits SS#__  __  __ __


Instructor___________________________________________Course #_____________________


SC #  SC_________________ (from CIS)



_______Airway    ______Assessment    ______CPR/AED     _________________Random Skill

If repeat make sure you list skill to repeat