HVA Citizens Academy
1200 State Circle
Ann Arbor, MI 48108
Registration Form
Name: _________________________________________
Address:_________________________________________
City: __________________________________________
State: _________________ Zip: ____________________
Daytime Phone: ___________________________
E-mail address: ___________________________
Age:_____ Circle One: M F Shirt size: ______
Why are you interested in the HVA citizens academy?
______________________________________________________
______________________________________________________
Residents of Washtenaw County 18 or older may register.
Registrations are limited and taken on a first-come, first-served basis.
Registration opens January 2nd. Please do not mail or fax your registration before this date. Any registrations postmarked or faxed before this date will not receive preferential placement.
Mail or fax completed registration to:
Jason Trojan, Community Relations Coordinator
Huron Valley Ambulance
1200 State Circle
Ann Arbor MI 48108
Fax: 734-971-4385
You will be notified by phone if you are registered for the academy.
The program is an 8 week commitment. If you have concerns regarding this matter,
please contact us by phone at 734-477-6781 to discuss.
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