Instructor: Hashunda McClendon

Invoice #: _0212

Date: 07/23/2026

Training Date: 07/25/2026

 

PARTICIPANT INFORMATION

Full Name: ______________________________________

Company/Employer: ______________________________

Email Address: _______________________________

Phone Number: ______________________________

 

 

REQUIRED CERTIFICATION VERIFICATION

Please upload or attach a copy of your current CPR certification card.

Upload Certification Card: ☐ Attached

Certification Expiration Date: __________________

Certification Provider:
☐ American Red Cross
☐ American Heart Association
☐ Other: _______________________

 

COURSE INFORMATION

Course:

☐ CPR Recertification

☐ CPR / First Aid / AED Recertification

Instructor: Hashunda McClendon

 

PAYMENT

Course Fee: $85.00

Additional Fees: $___

Total Due: $85.00

Payment Method:

☐ PayPal

☐ Cash App

☐ Credit/Debit Card

☐ Cash

☐ Other ___________________

 

Payment Status:

☐ Paid

☐ Unpaid

 

Authorized Signature: __________________________

Date: ________________________________________

Thank you for choosing 24hr Superior Diagnostic for your CPR training needs.