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CPR / AED PROGRAM

CPR / AED Individual Registration Form

Please complete form below to request an individual registration.

Required fields are marked with * below.

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

Participant Type: *
UB Registered Student UB Faculty / Staff Member Community

* Please choose course and enter in your preferred date:
BLS for Healthcare Providers ($50.00) Offered on Saturday mornings: * BLS for Healthcare Providers w/ First Aid ($60.00) Offered on Saturdays mornings: * BLS for Healthcare Providers w/ Pediatric First Aid($60.00) Offered on Saturdays mornings or Mondays: * 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: * *There will be no classes on the following dates:

* Will you require First Aid Training?
Yes No

Payment Options:

Cash, check, money order or credit cards will be accepted.
Payable to: R&I Services
You pay in person at the recreation office, 130 Alumni Arena or Clark Hall
Payments must be received 5 business days prior to the class
Payments will not be accepted at the door the day of class

- Bring proof of payment to class with you

Please send your payment to the following address:
CPR / AED Training Center
130 Alumni Arena
Buffalo, NY 14260

Please print this registration form and submit it with payment.

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

• Group Registration Form

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