Instructor Inquiry Form
Fill out the form carefully for us to be able to see if we are the right fit for you!
Name
*
First Name
Middle Name
Last Name
Are you 18 years or older?
*
Please Select
yes
no
What AHA Certification type do you have?
*
Please Select
BLS
Heartsaver
American Red Cross
Were you referred by an RN CPR instructor? if yes what is there name?
*
Do you have a current BLS provider card?
*
Please Select
yes
no, i am willing to get one
no
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
E-mail
*
example@example.com
Mobile Number
*
Format: (000) 000-0000.
Why do you want to become a CPR instructor?
Are you willing to follow RN CPR administrative policies and guideline updates?
*
Please Select
Yes
No
The BLS instructor course is $300. This includes alignment with RN CPR.
*
Please Select
Yes
No
As a BLS instructor you will be required to purchase equipment that is required by the AHA prior to teaching a course.
*
Please Select
Yes
No
Do you understand alignment approval is not automatic?
*
Please Select
I understand
That is not what I want to do
I have more questions
Do you have experience with BLS in the past and if so what experience?
*
Anything else we need to know?
Submit
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