Royalty Training Registration Form

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Please fill out the form below to register for a class with Royalty. You can only register for one class per form but you can submit multiple forms. If you have any questions feel free to email us at info@royaltyhwr.com or call 336-623-2547.

Agency *

Person *

Email *

I am registering for: *

Pediatric CPR/AED & First Aid

First Aid & CPR/AED (Adult Only)

BLS Basic Life Support

Basics of Medication Administration

Foster Parent Bloodborne Pathogens/ Medication Administration

Other:

CPR Course Materials (select all that apply)

I would like to download the participant manual at no charge

I would like to purchase a hardcopy of the Participant Manual for an additional $12

I would like to purchase a pediatric quick reference booklet for $4

I would like to purchase a adult quick reference booklet for $4

I would like a first aid quick reference for $3

Please invoice me separately for materials

I will pick up prior to class

I will pick up day of class

Please ship my materials for an additional $6

Date *

YYYY

Class Starting Time

Time

Payment Method *

Cash

Check

ACH (Check over the phone)

Card (Emailed Invoice)

Card (over the phone)

Employer will Pay

Laynecare Customer

Foster Parent Program

Other:

Employer or sponsoring agency: (if applicable)

Submit

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