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CPR Class Registration for Saturday, June 12th at 9:30AM- 1:30PM
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First Name
*
Please type your full first name. This will be used on the certification card.
Your answer
Last Name
*
Please type your full last name. This will be used on the certification card.
Your answer
E-mail Address
*
Please enter a husky or personal e-mail address. This e-mail will be used to contact you about the CPR class and receiving CPR cards after the class.
Your answer
Phone Number
*
Please provide a phone number that may be used to contact you.
Your answer
Major
*
What is your major?
Your answer
What year are you?
*
1st
2nd
3rd
4th
5th
6th
Graduate
Other:
Have you ever taken a CPR class before?
*
Yes
No
Address
Street Address
*
Ex: 123 Sesame Street, Apt. 1
Your answer
City, State & Zip Code
*
Ex. Boston, MA 02115
Your answer
What is your reason for taking this CPR class?
*
Please choose one that best fits you
Nursing, Pharmacy, PA, or PT student
Going on a co-op that requires a CPR certification
Working professional in career that requires CPR certification
Personal Knowledge
Other:
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