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Request CPR or Bleeding Control Class
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This form has been modified since it was saved. Please review all fields before submitting.
Contact Information for the Person Requesting
First Name
*
Last Name
*
Email
*
Phone
*
Class being requested
Hands-only CPR
GJFD Bleeding Control
Type of request
*
I'm requesting a class for just myself
I'm requesting a class for a group or organization
Group or organization details
The following information is only needed if you are requesting an event for a group or organization
Group/Organization Name
Number of people expected to attend
Class location
If you need GJFD to provide a training location, simply type "GJFD" for location.
A/V Equipment
-- Select One --
Yes
No
I'm not sure
Does your facility have access to a computer, projector, and screen?
Date and time Requests
Describe your availability for classes with dates and times, or days of the week and times as is appropriate to your group.
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