Individual Registration

PALS Part II Initial Skills Verification

Fees are non-refundable and non-transferable.
Session changes must be requested in writing and approved no less than 24 hours prior to originally scheduled date.
No call / NO show will result in forfeiture of fee and a new full fee being generated to reschedule skills session.
Verification of successful completion can and will be provided and card will be delivered electronically as soon as it is ready. ( this will take no more than 10 working days).

Tell us about yourself!

First Name *

Last Name *

Organization

Address *

Address 2

City *

State *

Zip *

Country *

Phone *

Email *

How did you learn about EOTP911? *

It is required that you provide 3 options for date/time you can attend.
- Sessions can run from 30 minutes to 2 hours depending on your skill level.
- Use 12-hour time with AM/PM or 24 hour format .

Date choice 1 *

Time choice 1 *

Date choice 2 *

Time choice 2 *

Date choice 3 *

Time choice 3 *

Is your Agency/Employer paying for this class? *

Yes

Agency/Employer Name *

Agency/Employer Point of Contact Name *

Agency/Employer POC Email address *

Phone number of Agency/Employer POC *

Please Enter the AHA Test Completion Number *

Payment Information

Coupon

Amount

Discount Amount

Gross amount

Payment Method

Paypal

Credit Card Number*

Expiration Date*

Card (CVV) Code*

Card Holder Name*

By register to this event and agreeing to the Privacy Policy you agree to this web site storing your information.

By registering for this event, I accept Terms and Conditions

Captcha*