AED & CPR Certification Class Registration Form

AED & CPR Certificate Class Registration Form

Please complete the registration. Space is limited.
August 6, 2026 • Event Time: 10:00 am - 4:00 pm

Event Address:

Brooklyn Public Library Flatbush Branch

22 Linden Blvd.

Brooklyn, NY 11226 • 718-856-0813

Limited spots available! Don’t miss out, secure your spot today.

Registration DOES NOT guarantee a seat; it is based on a first-come, first-served basis.
Participant Information
Full Name

PrefixFirst NameLast Name
Email Address
example@example.com
Contact Number
Please enter a valid phone number.Format: (000) 000-0000.
How did you hear about this class?

Other
Have you previously held an AED/CPR certification?
Have you attended MIPO's event (s) in the past?
Do you have any physical limitations, injuries or health conditions that may affect your ability to perform CPR compression practice or physical skills demonstrations (e.g., kneeling, bending, repetitive arm movement)
Emergency contact
Emergency contact

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Would you like to be updated on MIPO's upcoming events? Please note that opting out may prevent you from receiving invitations to future opportunities.
Waiver/Acknowledgment
I understand that this course involves physical participation, including kneeling, bending, and performing chest compressions. I agree to notify the instructor before class begins of any condition that may limit my participation.
Please verify that you are human.
Signature
Please be aware that this is a certificate program. If you decide not to attend, kindly inform us as soon as possible so we can offer that additional seat to someone else.
Should be Empty:

AED & CPR Certificate Class Registration Form

August 6, 2026 • Event Time: 10:00 am - 4:00 pm

Event Address:

Brooklyn Public Library Flatbush Branch

22 Linden Blvd.

Brooklyn, NY 11226 • 718-856-0813

Participant Information

Emergency contact

Waiver/Acknowledgment