Please completely fill out all of the information below and when completed, select submit. If you would prefer to print out the completed form and postal mail your registration, please fill out the form and print the page from your browser window.
After you submit, a confirmation web page will appear, thanking you. After we receive your application, a confirmation letter will be sent to you. Please be sure to indicate if you prefer an electronic (via email) or postal mail confirmation letter. The letter will include: instructions on fee payment, parking, information about consent and release of information and other details. If you would like to expedite this process send your $15 payment per student (remember chaperones attend at no cost) payable to UW-Platteville; Print and complete both the consent and release of information items for each student; and send via postal mail to:Women in EMS Program - Fall Career Day C/O Tammy Salmon-Stephens 1 University Plaza Platteville, WI 53818
The preferred application deadline is Monday, October 14, 2012. Applications will still be accepted, even after the preferred deadline if program enrollment is not reached. Please send an email to firstname.lastname@example.org to inquire about enrollment availability.
Questions can be emailed to email@example.com or by calling 608.342.1563.