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2. Contact Information for the Person Requesting
4. First Name*
5. Last Name*
7. Email*
8. Phone*
10. Class being requested

    1. Hands-only CPR

    1. GJFD Bleeding Control
12. Type of request*

    1. I'm requesting a class for just myself
    2. I'm requesting a class for a group or organization
14. Group or organization details
    The following information is only needed if you are requesting an event for a group or organization
16. Group/Organization Name
17. Number of people expected to attend
19. Class location
    If you need GJFD to provide a training location, simply type "GJFD" for location.
21. A/V Equipment
    -- Select One --YesNoI'm not sure

    Does your facility have access to a computer, projector, and screen?
23. 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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25. 1. Receive an email copy of this form.
26. Email address

    This field is not part of the form submission.

27. Submit

* indicates a required field