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Privacy Notice

The Reports listed below may obtained from the Licensing and Certification Section by completing the information listed below.  An e-mail of your request will be sent to the Licensing and Certification Section.  The Reports requested will be e-mailed to the e-mail address provided.

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          Name:                            Business/EMS Agency Name:            Agency License Number

 required.gif (158 bytes)     required.gif (158 bytes)   required.gif (158 bytes)  required.gif (158 bytes)
           Address:                                    City                          State:            Postal Code:

       required.gif (158 bytes)    required.gif (158 bytes)
          Phone:                             E-Mail Address:

  Reports Requested: required.gif (158 bytes)

Agency Information Sheet:    
 
              Personnel Listing:    
 
                 Vehicle Listing:    

After selecting the document(s), click on the "Register" Button ONCE ONLY

If you have questions or comments, or clicking on the "Register" Button results in an Error, contact the Licensing and Certification Section.

required.gif (158 bytes) = Required information

 
   
 

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Office of Emergency Medical Services and Trauma System
P.O. Box 47853,
Olympia, Washington, 98504-7853
Phone: (360) 236-2828
(Fax: 360) 236-2829 or 236-2830

Last Update : 03/28/2006 08:37 AM
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