CPR Course Application Please enable JavaScript in your browser to complete this form.Name *AddressAddress Line 1CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeEmail *PhoneEmployerAddressAddress Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeBusiness PhoneBusiness FaxDate you plan to attend course:Course Description:C.P.R. (Cardiopulmonary resuscitation) and A.E.D (automated external defibrillation) Lake Norman Dental Assisting School is a registered training center for The American Safety & Health Institute’s CPR and AED program. This program provides workplace and community training in performing CPR and using an automated external defibrillator (AED) _______________________________________________________________________________________________________________ The cost of the course is $80.00 community, $40.00 enrolled students.Cancellation, refund, and requirements policy:A full refund of all monies will be made to any applicant who cancels the enrollment agreement within THREE business days of the first class.Submit