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  • BLS-PROVIDER INSTRUCTORS TRAINING PROGRAM
    REGISTRATION FORM

    FILING DEADLINE - 12 NOON NOVEMBER 2, 2017

    CHECKS-ONLY MUST BE SUBMITTED WITH A COPY OF YOUR CURRENT C.P.R. CERTIFICATION CARD (BOTH SIDES).

    BOTH REGISTRATION FORM AND REQUIRED MANUALS PAGE MUST BE RETURNED TOGETHER.


    ** PLEASE PRINT NEATLY ALL INFORMATION **

    Name: ___________________________________________

    Home Phone :_____________________________________

    Address: _________________________________________

    City:_______________State:_________Zip:____________

    Organization/Departments Name:____________________


    I want to be Certified As a:
    AHA BLS-PROVIDER Instructor_______


    Classroom section of the course is Sat NOVEMBER 18, 2017 @9:00AM SHARP at the Chelsea Soldiers Home. 91 Crest Ave, Chelsea, MA 02150


    FILING DEADLINE - 12 NOON NOVEMBER 2, 2017

    Return this page and Required Manuals Form To Address Below:
    EMT-TA
    P.O. Box 994
    Saugus, Mass 01906-0194


    FOR REQUIRED BLS-PROVIDER INSTRUCTOR MANUALS FOR THE PROGRAM CLICK HERE