HEALTH & SAFETY TRAINING REGISTRATION:

FIRST NAME : LAST NAME:

HOUSE NUMBER :     STREET

CITY STATE ZIP

HOME PHONE: CELL PHONE

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SELECT CLASS BELOW

03/27/10-Babysitters Training 03/16/10-Infant/Child CPR & First Aid 04/17/10-Pet First Aid 04/26/10-Pet First Aid 03/29/10-Adult CPR/AED 04/12/10-Adult CPR/AED 04/20/10-Adult CPR/AED 04/28/10-CPR for the Professional 04/10/10-CPR for the Professional 03/24/10-First Aid 04/06/10 - First Aid 03/18/10-Infant/Child CPR 02/22/10 - Adult CPR W / AED - 02/22/10 - 5 to 9 04/1/10-Infant/Child CPR

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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