Registration

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"*" indicates required fields

Name*

Address*

Street Address Address Line 2 City State ZIP Code

Phone*

Email*

Are You a CLC Student?*

Date of Class:*

Classes*

BLS/HCP (Healthcare Provider CPR)

BLS/HCP (HEALTHCARE PROVIDER CPR)*

Price:

Total

Credit Card*

Cardholder Name

Card Details

A processing fee of $5 is included in the course price.
If a student does not show up, the cost remains forfeited.

Comments

Number

Name

This field is for validation purposes and should be left unchanged.