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Selected:

 

ADVANCED WEBSITE
This complete package provides a professional branded website with advanced features for listing classes and taking class payments! It includes a domain, email, and free listing. Just fill out the form to the right and click "submit".

 

Can I change the registration type later?  Yes! You can register today at any comittment level and then change your selection later should you want to upgrade or change plans.

 

PRIVACY AND CONFIDENTIALITY
We do not sell, rent, or exchange your private information with any other vendor. PLEASE NOTE HOWEVER that all information provided on this form WILL BE DISPLAYED PUBLICALLY.

 
REGISTRATION FORM
(review other options)

  

  Enter name and address  
 

  - Please enter your name, your business name, or both.

  - Items marked with * are requried.

  - Check off items that you would like to display in your public listing.
    THIS INFORMATION WILL BE DISPLAYED ON A PUBLIC LISTING. 
    Note that some items are mandatory for the public listing and are already
    checked off for you.

  
 

 

Primary Contact    List these items publically

First Name*:

Name
Last Name*:  
Business Name: Bus.

 Additional Instructors:

(separate names

with a comma)

  
  Instructors
Address*:
  Full
  Address
   
City*:  
State*:     Country:  
Zip*:  
County/Region:  
Phone Number*: Phone
Fax Number: Fax
email address*: email
verify email*:
(please re-type your
email address for
verification)		  
Password*:  
Website:
  Website

 		  
  Certifications and Classes  
 

  - Enter the certifications for you and your business as well as the classes that are
    taught by you and your team of instructors.

  - Your information is subject to verification and YOUR LISTING MAY BE REMOVED

    IF YOUR INFORMATION IS FOUND TO BE INCORRECT.

  
 

 

CERTIFICATIONS:

  ECSI Red Cross ASHI
  AHA National Safety
      Council		 Other:
    

  

 CLASSES:

CPR

     Lay

     Professional/Health Care

AED (Advanced External Defibrillator)

First Aid

     Standard

     Advanced

     Pediatric

     Wilderness

     Medic

ACLS (Advanced Cardiac Life

      Support)

Baby Sitter Safety

Bloodborne & Airborne
      Pathogens

Driver Safety

O2 Administration

OSHA

PedFacts

Pet First Aid
Other Class(es):


 

  
  Additional Comments  
 

  - This is an opportunity to tell a little bit about your services and what sets you

    apart from other instructors or businesses.

  - THESE COMMENTS WILL BE DISPLAYED IN YOUR PUBLIC LISTING.

  
      Sample of what to write:
      Our team of instructors has combined experience of over 17 years in CPR,
      First Aid, and other safety tips. We are known for our friendly and fun
      courses that teach new comers along with seasoned professionals. Please
      call us for more information.
 
 		  
 

 

  I AGREE TO ALL TERMS AND POLICIES AND VERIFY THAT THE INFORMATION ENTERED ABOVE IS TRUE AND ACCURATE.
 

  I would like to receive the ForCPR.com newsletter sent
regularly via email.