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2. Name*

   Please use the name you would like to appear on your CPR card

3. Email Address*

   This is the email address your electronic card will be sent to

5. Address*
7. City*
8. State*
9. Zip Code*
11. Phone Number*
12. Institution*
14. Which class would you like to attend?*
    -- Select One --AED/CPR no card needed $0.00AED/CPR card needed $26.00AED/CPR/First Aid $28.75BLS $40.00

    If payment is due, please bring a check made out to the City of Orange Beach on the day of class

16. 2022/2023 Course Dates:*

    1. Heartsaver AED/CPR August 1, 2023 6-9:00 PM
    2. Heartsaver AED/CPR/First Aid August 1, 2023 6-10:00 PM
    3. Heartsaver AED/CPR October 3, 2023 6-9:00 PM
    4. Heartsaver AED/CPR/First Aid October 3, 2023 6-10:00 PM
    5. BLS *for medical providers only October 17, 2023 6-9:00 PM
    6. Heartsaver AED/CPR November 7, 2023 6-9:00 PM
    7. Heartsaver AED/CPR/First Aid November 7, 2023 6-10:00 PM
    8. BLS *for medical providers only November 14, 2023 6-9:00 PM
    9. Heartsaver AED/CPR December 5, 2023 6-9:00 PM
    10. Heartsaver AED/CPR/First Aid December 5, 2023 6-10:00 PM
18. Note to Instructor:

    If you are signing up for the BLS class, please indicate if it is a renewal card and the date the card is needed. 

    
    

    Please email atoussaint@orangebeachal.gov if you have any additional questions

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20. 1. Receive an email copy of this form.
21. Email address

    This field is not part of the form submission.

22. Submit

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