Community Education Course Request

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If you, your group, business or school are interested in completing courses such as CPR and First Aid, complete this form and our public education coordinator will reach out to you. Feel free to contact our station at (219) 987-2021 if you have any questions.

Email *

Your Name *

Your Phone Number *

Your E-Mail Address

How Would You Prefer to be Contacted? *

By E-Mail

By Telephone

What is the best time to contact you? *

What Type of Courses are you Interested In? *

CPR

AED

First Aid

Other:

Required

Who are these Course For? *

For Me

For My Family

For My School or Special Interest Group

For My Business or Employer

Other

How Soon do you Want the Courses to be Completed? *

Other Notes/Comments:

Submit

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