Register FieldsetFirst Name *Last Name *Company Name Address *Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeAfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiaComorosCongo (Brazzaville)CongoCosta RicaCote d\'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast Timor (Timor Timur)EcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambia, TheGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalestinian TerritoryPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint VincentSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited States of AmericaUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamWestern SaharaWestern SamoaYemenZambiaZimbabweCountryPhone *Email *What course are you registering for? *BLS for Healthcare ProvidersHeartsaver First Aid CPR AEDHeartsaver CPR AEDHeartsaver First AidHeartsaver Pediatric First Aid CPR AEDFamily & Friends CPRBloodborne PathogensBLS for Healthcare Providers SKILLS TESTHeartsaver First Aid CPR AED SKILLS TESTHeartsaver CPR AED SKILLS TESTHeartsaver First Aid SKILLS TESTHeartsaver Pediatric First Aid CPR AED SKILLS TESTDo you need Child and/or Infant CPR? There is no additional charge for child or infant, however it may add extra time to your course's expected end time. (approx 30 min) *** Pediatric CPR includes child and infant. No extra timeChild OnlyInfant OnlyChild and InfantDate of Course *Course Start Time *010203040506070809101112HH000510152025303540455055MMAMPMAM/PMAdditional Students? Please enter the names and email addresses of any additional students you are registering.Payment Instructions ***After submitting your registration, you will be sent a PayPal Invoice to submit payment for your course within the next 24 hours. Please be aware that our courses are on a first come, first serve basis. Please make payment no later than 72 hours before your course to secure your appointment. If you have not made payment by then and your appointment is still available, you may pay upon arrival with cash or debit/credit card. ALL SALES ARE FINAL You may cancel within 24 hours of your appointment and reschedule. If a reschedule is needed, please do so within a 2 week period. ***GROUPS PAYING BY CHECK: If you have to cancel or reschedule your appointment, please do so at least 72 hours before your appointment. Your check payment should be received before the start of the course. There will be a $35 charge for any insufficient funds or NSF checks. VerificationPlease enter any two digits *Example: 12This box is for spam protection - please leave it blank:
