EMS Interstate Compact (REPLICA) Application EMS Interstate Compact (REPLICA) Agency Application Date of Application:* Agency Applying for EMS Interstate Compact (REPLICA) Staffing:*Agency OEMS License #:Agency Administrative Contact:* First Name Last Name Phone:*Email:* Requesting to utilize EMS Interstate Compact (REPLICA) providers from:* Month Day Year to* Month Day Year All fields must be completed for each EMS Interstate Compact (REPLICA) provider to be hosted.*First NameLast NameHome StateLicense #License LevelLicense Expiration DateContact Number*National EMS I.D. # * Your National EMS I.D. number is the 12-digit numerical number found on your National Registry account. It is NOT your National Registry number. Last Updated: April 28, 2020