CPR REGISTRATION FORM

	Please submit one form per individual






Name: ________________________________________    		         Date of Request: ________________

Home Phone #:  ___________________ Work Phone #: _____________________   Date of Class:  ____________

Type of Class  –  Please check the type of class you prefer to enroll in -  

CPR	Level B - $20    ?  or   Level C - $25	  ? (Health Care providers)
             
CPR classes are scheduled the 2nd and 4th  Wednesday of every month from 6:00 – 10:00 PM and are held
at the following location:	 Baldwin House
 	             	 10401 No. 79th Ave.
       
These classes require