Gorman and Accociates CPR

General Registration Form

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

PLEASE CHOOSE A DATE FROM THE CALENDAR PAGE BEFORE YOU FILL-OUT THIS FORM!

A CONFIRMATION E-MAIL WILL BE SENT TO ALL PARTICIPANTS.

ALL PARTICIPANTS MUST BRING THE CONFIRMATION LETTER AND THIS FORM TO BE ADMITTED TO THE CLASS.

CLASSES ARE HELD AT THE COMFORT INN, SPRINGFIELD, VA

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For DIRECTIONS to the Comfort Inn: CLICK ON CONTACT US, then DIRECTIONS on the left side of this page. .

Contact Information

First Name:
Last Name:
Training Requested For:
(Job Description)
E-mail:
Home Address:
City, St, Zip:
Business Phone:
Home Phone:
Fax:
Supervisor's Name: (not required for self pay)
   

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

Courses
 Date Requested
 Rate*
  • Adult & Child CPR/AED**
  • Sign-in @ 8:30am
  • Class 9am-12pm
  • Infant CPR 12pm-12:30pm (optional)
 (1)
  		$65.00
  • Basic First Aid
  • Sign-in @ 12:45pm
  • Class 1:15pm-4:30pm
 (1)
 		 $55.00
  • Healthcare Provider (Retraining Only)
  • Evening Sessions

Please view our calendar or call  703-941-0999 to request dates and times.

 

 CALL 703-941-0999 IF YOU ARE LOST: NO ADMITTANCE 15 MINUTES AFTER THE START OF A COURSE.

Payment Method:
 PLEASE NOTE: PAYMENT METHOD SELECTIONS ARE FOR REGISTRATION PURPOSES ONLY. ALL PAYMENTS ARE DUE AT SIGN-IN PRIOR TO COURSE. PRE-PAYMENTS ARE ENCOURAGED BUT NOT REQUIRED. PLEASE CALL 703.941.0999 FOR PRE-PAYMENT OPTIONS.
   

* Rate includes $10.00 manual. 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 use for this course; written test will be given upon completion of Adult CPR skills.