If you are new to American CME and did not have an agency account previously on our old site, please fill out this form. Agencies that had accounts previously do not need to fill out this form. Thanks!

Agency Name *

Provide full name of agency

Parent Organization

Provide name of affiliated Medical Control Authority (MCA).

State or Province *

In what US state or Canadian province are you located?

Organization Type *

• Fire Department
• Ambulance Service
• Public Safety Department
• Airport
• School
• Other

If agency type is Other, what type of agency?

Link to agency logo or homepage showing logo

Email us a 250 x 250 pixel png file logo or provide a link to it here, and we'll resize it.

Number of Sub Accounts (Personnel) *

Do you plan to purchase CAPCE subscriptions for your agency personnel? If so, how many seats?

A custom membership plan for your organization will be created based on the number of personnel. The agency discount if $60/person (regular price is $95)

Email *

Phone

We'll email or call if we have questions. Thank you!

Submit