UMass Lowell EMS CPR Application Summer 2015

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Please fill out the following information:

Contact Information

Last Name *

First Name *

Phone Number *

E-mail Address *

If you do not have an e-mail address, please enter "N/A"

Address *

(Street, City/Town, State, Zip Code)

If UMASS Lowell student, what is your major?

If not a student, please leave blank.

Courses Taught

Healthcare Provider CPR with First Aid ($90; w/out First Aid $70)
New Certification - includes pocket mask

Healthcare Provider CPR Refresher ($45; w/ First Aid $65)
*** Must have current, non-expired HCP CPR certification***

Heart Saver CPR ($45)
Basic lay person CPR and AED

First Aid ($20)

Which course are you registering for? *

First Aid is offered in combination with classes, contact us at umlems_cpr@uml.edu for only First Aid

Health Care Provider Initial

Health Care Provider Recert (Refresher)

Heart Saver CPR and AED

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