Gorman and Accociates CPR

On-Site Group Request Form

AHA Heartsaver CPR (2 year cert.) or First Aid (3 year cert.)

Please use this form to request group training at your job site.

Contact Person

(Must be available at course site 30 minutes prior to course)

First Name:
Last Name:
Facility / Organization / Department
E-mail:
Business Address:
City, St, Zip:
Business Phone:
Fax:
Location of course / Training Room:
Parking Instructions
Approx. # of participants:
Course requested by:
   

ALL COURSES ARE TAUGHT AND TESTED IN ENGLISH

(Accommodations for language challenges must be made in advance)

   

Special Requirements

Wheelchair Access
Interpreter
Other:  
   

Course Selection

Available Courses
Course sizes min. 8/max. 48		 Dates Requested
Show 1st and 2nd Choice Date & Start Time		 Rate
(Includes $10.00 Manual)*
First Aid Certification
4 hours		 (1)
(2) 		$50.00
Adult CPR
3 Hours		 (1)
(2) 		$55.00
Adult & Pediatric CPR**
4 Hours		 (1)
(2) 		$60.00
Adult AED
4 Hours		 (1)
(2) 		$65.00
Healthcare Provider
3 Hours 		(1)
(2) 		$85.00
Seminars:
up to 90 minutes
(1) Universal Precautions
(2) Health Screening
(3) Introduction to CPR/FA		 (1)
(2) 		$175.00
 

Payment Method:
 
   

* Participants that present appropriate manual at course will not be charged for a duplicate manual

**Adult & Pediatric CPR approved for lifeguards, childcare providers, licensed nursing assistants, etc.

ADULT ONLY CPR -Adult & Pediatric rate at this course/Written test will be given upon completion of Adult CPR skills