CPR / FIRST-AID INSTRUCTORS TRAINING PROGRAM
FILING DEADLINE - 12 NOON MONDAY April 16, 2012
CHECKS-ONLY $ 125.00 MUST BE SUBMITTED WITH A COPY OF YOUR CURRENT C.P.R. CERTIFICATION CARD (BOTH SIDES).
** PLEASE PRINT NEATLY ALL INFORMATION **
Name:___________________________________________
Home Phone :_____________________________________
Address:_________________________________________
City:_______________State:_________Zip:_____________
Organization/Departments Name:______________________
CHECK ONE LEVEL ONLY: I want to be Certified As a
Healthcare Instructor_______
Heartsaver Instructor_______
FILING DEADLINE - 12 NOON MONDAY April 16, 2012
Return Registration Form To Address Below:
EMT-TA
P.O. Box 994
Saugus, Mass 01906-0194
