2023 - Ride To End Alzheimers (RTEA) Registration

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Password*

Retype Password*

First Name  *

Last Name  *

Address  *

Address 2

City  *

State

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Email  *

Medical Level  *

--Select-- None FA/CPR EMR/ECA EMT AEMT EMTP/LP

DSHS Number

DSHS Expiration Date

Open the calendar

If you are a HAM, what is your Call Sign?

Do you ride a motorcycle?  *

Yes

No

Please provide the name of an emergency contact:  *

Emergency Contact Phone Number (cell prefered):  *

Emergency Contact Email:  *

What area do you want to work in? (Select all that apply)  *

EMS

Comms

Support

What T-Shirt size do you wear?  *

S

M

L

XL

2XL

3XL

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What is your MMRT Unit number?

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