Online CPR Registration Form

Provide the following information exactly as you would like it to appear on your completion card. We will contact you by telephone within 24 hours with payment instructions. All classes subject to minimums & cancellation.

 

 

Choose One	Course Registration RequestCourse Information Request
First  Name	M.I.
Last Name
Occupation
Street Address	Apt.
Village/City
State	Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming zip
Phone #
E-mail
Course Name	Select One 04/17/10 - AHA Heartsaver Pediatric First Aid 04/17/10 - AHA BLS for Healthcare Providers
Question  or Comment
Preferred Payment Method	Paypal (Paypal invoice will be sent via e-mail). Google Checkout (Google checkout will be sent via email). Credit Card - Online (Credit card directions will be sent via email.) Check (Check must be received at least 7 days prior to class date.) All course fees are based on  advance registration and payment. Walk-up students will not be accepted. Due to the small size of all classes, refunds will not be issued within 14 days of class. If you call and notify us of your inability to attend, an attempt will be made to place you in another class at no additional cost. "No Shows" will not be given this consideration.