CPR Training Reservation and Enrollment Form

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Our monthly public CPR classes are offered on the 2nd Saturday of each month and are free to attend. If you require a card, the cost of the CPR card is $35.00. If you need to cancel your registration, call 251-626-8876.

Best Phone # to contact you *

123-456-7890

First Name *

Last Name *

Courses you wish to attend *

Heartsaver CPR AED is known as the public or layperson training. BLS Provider CPR with AED is the class formally known as "Healthcare Provider CPR".

Heartsaver CPR AED

BLS Provider CPR with AED

CPR Course

First Aid is offered as an additional and separate class that is taught by request only following the CPR training. The class takes an additional 2 hours of classroom time. The $50.00 fee includes a CPR card and a First Aid card.

Yes

First Aid

Course Experience *

This is my first CPR course

I am renewing a prior CPR certification

Experience

Monthly Class you wish to attend? *

Do you require a CPR card? *

Cards are processed through our Community Training Center and my take up to 30 days to receive. We can provide a letter of attendance upon completion of the class, just ask your instructor.

Yes. I will provide payment of $35.00 (Cash or Check) at the beginning of class.

No. I do not require a card.

Your Name as it should appear on the CPR card? *

Submit

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