Course Registration Form

Course Registration Form

Please Complete
Which courses would you like to registering for?*

BLS (Basic Life Support) for Healthcare ProvidersAdult and Pediatric First-Aid/CPR/AEDHIPPABasic and Enhanced Infection Control Online CoursePhysical Examination and Health Assessment
Participant Name*

First NameMiddle NameLast Name
Birth Date

MonthDayYear
Gender
Address*

Street Address

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CityState / Province

Postal / Zip Code
Participant E-mail*
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Mobile Number*
Company*
If taking the course independently put N/A
Work Number
Additional Comments

Please choose the courses your are registering for: *

BLS (Basic Life Support) for Healthcare Providers

$80.00

First-Aid/CPR/AEDAdult and Pediatric

$65.00

HIPPA

$50.00

Basic and Enhanced Infection Control Online Course

$70.00 Quantity

Physical Examination and Health Assessment Online Course

$129.99 Quantity

Lung and Heart Sounds Online Course

$139.99 Quantity

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Total

$0.00

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