EmailMe Form - CPR Registration Form

Name *

First Last

Enter your name as it should be printed on your certification card.

Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code

Your address is used to mail some certification cards. Please enter a valid address. Lost CPR cards due to an incorrect address will result in $15 replacement fee.

Phone *

### - ### - ####

Your phone number will be used to contact you in case of last minute changes.

Email *

Your email will be used to send out course cards, reminder emails and invoices if selected.

Confirm Email

Employer Name

If you are taking the course for work requirements please enter employer name here.

Certification Level You Are Registering For: *

BLS Provider Initial Certification

BLS Provider Renewal

Heartsaver CPR AED Initial Certification

Heartsaver CPR AED Renewal

First Aid or Bloodborne Pathogens Only

If you are unsure, please refer to the links above to determine which course is right for you.

Date You Are Registering For: *

Additional Dates Coming Soon, contact us for groups of 3 or more.

Do You Need A First Aid Course?

Yes

No

First Aid course dates may differ from CPR course dates above. We will contact you after registration to schedule a date. Groups of three or more that need First Aid training, please contact the fire department directly.

Do You Need A Bloodborne Pathogens Course?

Yes

No

Bloodborne Pathogen course dates may differ from CPR course dates above. We will contact you after registration to schedule a date. Groups of three or more that need Bloodborne Pathogens training, please contact the fire department directly.

Payment Method: *

Cash or check payable upon sign-in on course day.

PayPal/Credit Card invoice payable prior to course day.

If PayPal/Credit Card is selected, an emailed invoice will be sent to your email address entered above for payment.