Momentum Neuchatel - Registration

Attention: Only First Responders with a valid certificate can register. Each registration will be verified and approved.

Please insert the required data in the following form.

Profile

E-mail address *Password *Confirm password *

Password must be:
- at least 8 characters long
- contain at least 1 special characters
- contain at least 1 numbers
- contain at least 1 uppercase letters
- contain at least 1 lowercase letters

Personal information

First Name *Last Name *Date of birth (dd-mm-yyyy) *Cell phone *Street address *Postal code *City *State *

Rescue experience

Do you have healthcare training? *

No Yes

If so, what type? Do you work in rescue operations? *

No Yes

If so, where?

BLS-AED certificate

Certification date (dd-mm-yyyy) *Issued by *

Certificate *

Take a picture of the certificate with your phone and upload it Max photo size: 16 MB

Notes

General terms and conditions

General conditions

I have read and agreed to the terms of use *

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