Cpr First Aid Training Request Form - Voice

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CPR/FIRST AID TRAINING REQUEST FORM
VOICE/CSEA will provide grant funds to sponsor Infant/Child/Adult CPR/First Aid Classes
for family, group family, and legally-exempt child care providers including staff and volunteers.
•
We will pay for the cost of the training and the space
•
You must complete the following so we can set up payment
•
You will need to register a minimum of 7 participants for the class
Chapter Representative or Training Coordinator
Contact Name__________________________________________________________
Email Address__________________________________________________________
Daytime Telephone Number_______________________________________________
Training Organization
Contact Name__________________________________________________________
Email Address__________________________________________________________
Daytime Telephone Number_______________________________________________
Space Rental
Contact Name__________________________________________________________
Email Address__________________________________________________________
Daytime Telephone Number_______________________________________________
Training Date & Time______________________________________________________________
Training Location_________________________________________________________________
Number of Participants_____
The completed application can be emailed or mailed to the following:
EMAIL
MAIL
CSEA WORK Institute, 1 Lear Jet Lane, Suite 5, Latham, NY 12110
ATTEN: CPR/First Aid
For more information contact CSEA WORK Institute
1-855-472-6848

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