Lakeshore Technical College - Emergency Response for Healthcare Registration

Home > Public Safety Training Center > Emergency Response for Healthcare Registration

Registration: Emergency Response for Healthcare Course

Welcome to the registration page for the Emergency Response Healthcare Training. All users of the training site must complete a new user registration form in order to access the courses. This is a simple process that will capture needed information about you necessary to personalize your file. This demographic information will be shared with the Wisconsin Division of Public Health Hospital Disaster Preparedness (DPHHDP), which provided funding for the development of these courses.

Before proceeding you must read and accept the following release of information.

* = required field

I have read and accept the terms of the release of information.

*First Name:

*Last Name:

*Username (as was provided by your employer):

*Address:

*City:

*State:

*Zip Code:

*Phone Number:

*Date of Birth (YYYY-MM-DD):

*Highest Grade Completed at Enrollment:

County of Residence

Email address:

Ethnic Background:

Gender:

*Name of Employer:

*Address of Employer (Street, City, Zip):