ALS Examination Registration Form ALS Examination Registration FormExam information Please refer to the ALS exams section of our website to see a current list of ALS exams.Exam date requested: Location: *Level: *AEMTIntermediate / 85Intermediate / 99ParamedicExam Attempt: *InitialRetestPrevious test date: Previous test location: Candidate InformationLegal name: *Address: *City: *State: *Zip Code *Home Phone: *Cell Phone: Email: *Date of birth: *Current certifications:Current National Registry Certification: *YesNoNational Registry number: Expiration date: If you do not have National Registry certification, do you hold a current State certification: YesNoState certification held in: Level of certification: Certification number: Expiration date: A copy of you current out-of-state certification is required, please upload a copy: Course Information:Course number: *Course instructor: Course completion date: *Course location: For non-New Hampshire training programs please include a copy of a letter or certifcate of completion from the State authorizing the EMS training program. Please upload a copy here: VerificationPlease enter any two digits with no spaces (Example: 12) *This box is for spam protection - please leave it blank: