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EMS Professional Qualification:

Role In Emergency Care:   (Please √ the appropriate box’s)

EMT - Basic/Preparatory
EMT - Intermediate
Emergency Paramedic/ Advanced
EMS Instructor
Emergency Nurse
Physician ER/EM/Specialist/Consultant
Administrator/ Manager
EMS Dispatch Executive
Pilot/ Ambulance Driver
Medical Director

Membership type: (please ‘√’ the appropriate box)

Active Member-EMT's/ Paramedics/ EMS Instructors
Student Member-EMT's/Paramedic Students
Associate Member (Type1) - Doctors/ Medical Directors/ Managers
Associate Member (Type2) - Emergency Nurse/ Administrators/ Allied Health professionals
Associate Member (Type3) - Pilot/ Ambulance Driver

Professional

Are you a NRI EMS Professional ?     Yes   No 
    I Agree
Declarations: I firmly declare that the above mentioned information is accurate as per my knowledge. I authorise SAP committee for any verification, evaluation and willing to submit any further details if required. I will adhere to the best interests and objectives of SAP.

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