Cleveland Emergency Medical Service
Community Education and Training
Career Day/Public Awareness Registration Form
Instructions: This is an interactive form. Fill in the information below. This form can be saved and
submitted via email attachment to EMSCommunityEdu@city.cleveland.oh.us , Fax: 216-420-8373, or
printed and returned to:
City of Cleveland
Division of Emergency Medical Service
Attn: Community Education and Training
1701 Lakeside Ave
Cleveland, Ohio 44114
For questions regarding Career Day/Public Awareness, contact Community Education and Training at
(216) 664-6010 / (216) 664-2117 or EMSCommunityEdu@city.cleveland.oh.us
Organization Name:
First Name: Last Name:
Job Title:
Address:
City: State: Zip Code:
Phone No: Fax No:
Email Address:
Other Ph No:
Location of Event:
Date: Start Time: End Time:
How many people are expected to attend the event:
Career Day Public Awareness Event
Event Information
Organization Contact Information
*Important*
These services are only offered for Career Days and Public Awareness Events within the City of Cleveland
(Revised 7/2015)
