CPR Interest Form - United General District 304

Organization Name*

Contact Name*

First Last

Contact Email*

Phone

Estimated number of participants to be trained*

Please note that class size is capped at 12. If you have more than 12 people to be trained, we will work with you to determine the number of classes to be scheduled.

What days/times are convenient for your organization? (check all that apply)*

Weekdays from 4-6pm
Weekdays from 6-8pm
Weekends
I'd like to request a specific date
Other

What date(s) would you prefer?*

Other (please provide more info):*

Where would you like your training class(es) to be held?*

CPR training classes at our facility are held in the Wellness Center to the left of the main hospital entrance located at 2000 Hospital Dr., Sedro-Woolley.

Our facility on the Sedro-Woolley hospital campus
Your facility or other location

Location where the class(es) will be held:

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

CPR, AED & First Aid Class Interest Form