Home > Muskegon County MCA > White Lake Ambulance Authority White Lake Ambulance Authority This enrollment form is for the agency administrator(s) only. Personnel are added by the administrator. First Name:* First Name Required Last Name:* Last Name Required Email:* Email is Required License Type:* License Type is Required EMREMTEMT-1EMT-BEMT-DEMT-IntEMT-2EMT-CCEMT-PParamedicPCPACPAEMTCFROtherNone State Issued:* State Issued is Required AlabamaAlaskaArizonaArkansasColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundlandNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Territory State License Number:* State License Number is Required State License Expiration (Date Format Required):* State License Expiration (Date Format Required) is Required NREMT No. (Optional): NREMT No. (Optional) is not valid NREMT Re-registration Date (Required if NREMT No. provided): NREMT Re-registration Date (Required if NREMT No. provided) is not valid Your City of Residence:* Your City of Residence is Required State of Residence: State of Residence is not valid AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginaWashingtonWest VirginiaWisconsinWyoming Zip Code:* Zip Code is Required Username:* Invalid Username Email:* Invalid Email Password:* Invalid Password Password Confirmation:* Password Confirmation Doesn't Match Password Strength Password must be "Medium" or stronger This site collects names, emails and other user information and never sells user information. By agreeing to this policy, you consent to the terms set forth in the Privacy Policy. If you are taking CAPCE accredited courses, you additionally understand that American CME will submit a record of your CAPCE course completions to the CAPCE AMS. You further understand that course completion records may be accessed by or shared with such regulators as state EMS offices, training officers, and NREMT on a password-protected need-to-know basis. In addition, you understand that you may review your record of CAPCE accredited course completions by contacting CAPCE. No val Please fix the errors above Username Password Remember Me Forgot Password