Waiting List Registration
If a seat becomes available you will receive a confirmation email
Heartsaver First Aid/CPR/AED
Tuesday, January 28, 2020
6:00 pm - 9:00 pm
Location: MCTC - Camp Dodge
Directions: 7105 NW 70th Avenue, Johnston, IA 50131

Heartsaver CPR/AED

Tuesday 6:00 PM to 9:00 PM

Cost: $75.00

STUDENT CONTACT INFORMATION
 * required
First Name:*

Last Name:*

Position/Title/Rank:*

Sworn Law Enforcement Officer

Phone : (e.g. ###-###-#### - ext)*

Cell Phone: (include area code)

Fax Number: (include area code)

E-mail:*

Verify E-mail:*


IDENTIFYING INFORMATION
DL# * 

 

AGENCY / ORGANIZATION NAME

Agency City:*

Agency State:* 
(ie: IA)		 Agency Zip code:*
AGENCY / ORGANIZATION TYPE
Municipal County State Federal
Other (please provide details)


SUPERVISOR INFORMATION
(For Law Enforcement Status Verification)
Full Name

Phone Work: (e.g. ###-###-#### - ext)

Supervisor E-mail:* (will receive confirmation email)

 

 Credentials Required at Registration