HVA Behind the Scenes 2013 logo

   REGISTRATION FORM

 

First Name:   Last Name:

Address:

City:   State:  Zip:  

Day Phone:   Email:

Birth Date (MM/YYYY): You must be at least 18 years old to participate.

In the box below tell us why are you interested in the HVA Behind the Scenes?


Click submit to process your registration   

If you are unable to complete this form online, please print it, complete it and mail it to:

Jason Trojan
Huron Valley Ambulance
1270 Goldsmith
Plymouth Township, MI 48170

HVA Behind the Scenes is a 6 week commitment on consecutive Wednesdays from April 3 through May 8. Anyone 18 or older who is a resident of Washtenaw County or in the western Wayne county communities of Belleville, Plymouth, Plymouth Township, Sumpter Township, or Van Buren Township may register.

You will be notified by phone to confirm your registration.

If you have and questions, call Jason Trojan at (734) 477-6781 or email jtrojan@emergenthealth.org

HVA Behind the Scenes

1200 State Circle

Ann Arbor, Michigan 48108

www.hva.org