CPR/First Aid Training Registration

1. Default Section

Please fill this registration form out in order to confirm your spot in the upcoming American Red Cross CPR/First Aid training.

Question Title

* 1. Basic Information:

Name: *

Address: *

Address 2:

City/Town: *

State: *

ZIP: *

Date of Birth (MM/DD/YYYY) *

Email Address: *

Phone Number: *

Question Title

* 2. Gender:

Male

Female

Question Title

* 3. Have you ever gone through CPR/First Aid training before?

Yes, I was previously certified.

Yes, but it was not a certification course.

Question Title

* 4. Are you an IYDE mentor?

Yes, I have gone through the training.

No, but I am scheduled to go through the training.

No, but I would like to receive information about the mentor training program.

No, I am not interested in the mentor training program.

Question Title

* 5. Which CPR training dates are you registering for?

October 1-2, 10am-4pm each day

November 19-20, 10am-4pm each day

American Red Cross CPR/First Aid certification is a requirement for IYDE Certified Mentors, so we provide this training to you as part of your enrollment in the Mentor Certification Training (MCT) program, at no additional cost to you.

If you are NOT going through this training for the MCT program, the cost for you is $50 for a 2 year certification in: Adult/Child/Infant CPR, AED, First Aid

For all registrants, we require a $50 deposit to secure your spot in the training.

For IYDE mentors, your deposit will be returned to you when you complete the training, or if you cancel your registration at least 48 hours prior to the start of training.

For all others, your deposit will become your payment once you complete the training. The deposit will be returned to you if you cancel your registration at least 48 hours prior to the start of training.

If you make your deposit by check, we will hold your check until the training.

If you make your deposit by credit card, we will hold your credit card information until the training. You will only be charged if you do not attend the training and fail to inform us at least 48 hours prior to the start of class.

Question Title

* 6. Please select your registration type:

Mentor registration

Non-Mentor registration

Question Title

* 7. Please select your method of payment:

Cash (please mail or drop off to IYDE office)

Check (please mail or drop off to IYDE office)

Credit Card (please contact the IYDE office immediately to provide your credit card information)

Other (please specify)