CPR Registration Form - United General District 304

CPR, AED, and First Aid Class Registration

Name(Required)

First Last

Email(Required)

Phone(Required)

I qualify for a discount because my household receives one or more of the following benefits:(Required)

Basic Food, WIC, Apple Health

Yes

No

Which benefits does your household receive? (check all that apply)(Required)

Basic Food (SNAP)

WIC (Women, Infants & Children)

Apple Health

Please choose one of the following classes to attend:

Thursday, November 2 from 1:30 - 3:30 pm | blended learning class

Price: $80.00

Thursday, November 2 from 4 - 6 pm | blended learning class

Price: $80.00

Friday, November 17 from 9 am - 1 pm | traditional in-person class

Price: $100.00

Please choose one of the following classes to attend (at the discounted rate):

Thursday, November 2 from 1:30 - 3:30 pm | blended learning class

Price: $55.00

Thursday, November 2 from 4 - 6 pm | blended learning class

Price: $55.00

Friday, November 17 from 9 am - 1 pm | traditional in-person class

Price: $80.00

Payment

Note: Payment for CPR classes is non-refundable. If you cannot attend the in-person class on your scheduled date, please contact Stephanie at Stephanie.Morgareidge@UnitedGeneral.org as soon as possible. You may be able to reschedule to a future class or transfer your spot to another person.

Total

Billing Address(Required)

Street Address Address Line 2 City State ZIP Code

Credit Card

Card Details

Cardholder Name