CPR / AED Individual Registration Form

Name: (first & last)
Address:
City:
State:  
Zip Code:
Phone:
Email:
Check one:
UB Registered Student 
UB Faculty/Staff 
Community

PLEASE BE ADVISED:

As of August 1, 2013, First Aid will only be provided on Tuesday evenings & Saturday mornings.
Will you require First Aid Training?   *if Yes, please select a Tuesday or
                Saturday class date
Check Course:
BLS for Healthcare Providers                                                     $55.00
      Offered on Monday evenings or Saturday mornings

 BLS for Healthcare Providers with First Aid                                $65.00
      Offered on Saturday mornings

BLS for Healthcare Providers with Pediatric First Aid                    $65.00
      Offered on Saturday mornings

Heartsaver CPR & AED (Adult & Child, Infant Optional)                $55.00
      Offered on Tuesday evenings

Heartsaver First Aid with CPR & AED                                          $65.00
      Offered on Tuesday evenings

Monday Class Time:   6pm - 10pm
Tuesday Class Time:  
6pm - 10pm
Saturday Class Time: 
9am - 1pm

**NO CLASS on SATURDAY, September 2nd and MONDAY, September 4th due to the Labor Day Holiday**

ATTENTION
: Please be advised during the event of inclement weather, CPR Classes will be cancelled when the University at Buffalo has closed. Please visit www.buffalo.edu for information regarding any university closures.

Please select your preferred class date: *

Submitting the registration form does not automatically sign you up for the class of your choice. You will receive an email confirming date/time/location of the class to which you are assigned.