10-4-22 First Aid

 
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 CPR/AED/FA Registration 
This form is to be filled out completely for registration of CPR/FA classes

 
1.
*
Enter name of person completing registration.
 
   
2.
*
Title of person completing registration.
 
   
3.
*
Enter name of school.
 
   
4.
*
Mailing address of school for invoicing.
 
   
5.
*
Phone number of person completing registration.
 
   
6.
*
Email address of person completing registration.
 
   
  Registration and Payment/PO must be received 24 hours before class begins.

NO AT THE DOOR REGISTRATION

Cancellations and refund requests must be made one full working day before the class you are scheduled to attend. To cancel call or email Elizabeth Robinson at 530-842-8405 or erobinson@siskiyoucoe.net
   
7.
*
Number of Participants
The value must be greater than or equal to 1.
 
   
8.
*
Names of participants attending CPR/FA class.
 
   
9.
*
*SINGLE CLASS ONLY* This is the total cost of $40 per participant. (10 participants x $40 = $400)
*FOR CPR & FA* This is the total cost of $70 per participant. (10 participants x $70 = $700)
The value must be greater than or equal to 70.
 
   
  Please make your check or purchase order payable to:

Siskiyou County Office of Education

Please mail to:

Siskiyou County Office of Education
609 South Gold Street, Yreka, CA 96097
ATTN: Elizabeth Robinson

Or fax to:
530-842-8437
   
 
 
 
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