HEALTH & SAFETY TRAINING REGISTRATION:

FIRST NAME : LAST NAME:

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HOME PHONE: CELL PHONE

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SELECT CLASS BELOW

08/04/10-First Aid 09/01/10-First Aid 09/08/10-Adult CPR with AED 09/11/10-CPR for the Professional 09/14/10-First Aid 09/16/10-Infant and Child CPR 09/22/10-CPR for the Professional 09/28/10-Adult CPR with AED 08/05/10-Adult CPR with AED 08/17/10-Infant and Child CPR 08/24/10-Adult CPR with AED 07/30/10-Pet First Aid

YOU ARE NOT REGISTERED FOR THIS CLASS UNTIL WE HAVE RECEIVED YOUR CHECK OR PAYMENT.

TO PAY BY CREDIT CARD PLEASE USE SECURE FORM BELOW OR CALL TINA LAWTON AT (570)207 - 0117

Pay By Check!

Mail Check to:

American Red Cross of Lackawanna County

Attn: Health & Safety Training

545 Jefferson Ave.

Scranton, PA 18510

IF PAYING BY CHECK USE Card # 1234567887654321  Exp 9999

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