Emergency Medical Technician Licence Application

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Personal information on this form is collected by the Emergency Medical Services Board of Prince Edward Island under the authority of the Prince Edward Island's Emergency Medical Technicians Act and Emergency Medical Technicians Regulations. This information will be used to determine eligibility for an emergency medical technician (EMT) licence and to maintain a register of licensed EMTs in the province. The collection, use, or disclosure of this information must be in accordance with the Freedom of Information and Protection of Privacy Act, R.S.P.E.I. 1998, c.F-15.01. If you have any questions about this collection of personal information, contact the Director, Emergency Health Services; 16 Fitzroy Street, 3rd Floor Sullivan Building, PO Box 2000, Charlottetown, PE, C1A 7N8 or by phone at 902-368-6719.

For example C1B 0X1 or 12345
For example 902-555-5555
For example 902-555-5555