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CPR / AED Individual Registration Form

Required fields are marked with * below.

Name *
Address *
City *
State *
Zip Code *
Phone *
Email *

Check one: *
UB Registered Student UB Faculty/Staff Community

* Check course. Enter your preferred date:
BLS for Healthcare Providers ($50.00) Offered on Monday evenings or Saturday mornings: * BLS for Healthcare Providers w/ First Aid ($60.00) Offered on Monday evenings or Saturdays mornings: * BLS for Healthcare Providers w/ Pediatric First Aid($60.00) Offered on Monday evenings or Saturdays mornings: * Heartsaver First Aid w/ CPR & AED ($50.00) Offered on Tuesday evenings: * Heartsaver First Aid w/ CPR & AED (infant & child) ($60.00) Offered on Tuesday evenings: * Recertification Courses Offered on Monday evenings: *

* Will you require First Aid Training? Yes No

Payment method: cash check credit other

Staff intitials _____ Receipt #_________ Transmittal #______________

Send payment and printed registration form:
CPR / AED Training Center
130 Alumni Arena
Buffalo, NY 14260

Submitting the registration form does not automatically sign you up for the class of your choice. You will receive an email confirming date/time/location of the class to which you are assigned.

CPR / AED PROGRAM

• Individual Registration Form

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