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 PDF EMS CertificateWallet Card Replacement Form 2021-2023

PDF EMS CertificateWallet Card Replacement Form 2021-2023

Use a tx wallet 2021 template to make your document workflow more streamlined.

149347 Austin Texas. 78714-9347 No fee return by Email of Fax Email emscert dshs. texas. gov or Fax 512 206-3779 Section 1 Personnel Data TYPE OR PRINT IN BLACK INK Select Information EMT EMS Instructor EMS Information Operator Instructor Fee Enclosing 10 EMT-P Advanced EMT ECA Exempt from fee Licensed Paramedic Coordinator Are you requesting a copy of your If exempt complete Section 2 - Volunteer Sign-Off below. See http //www. dshs. state. tx. us for more information on Privacy Notification....
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