american red cross first aid & cpr training schedule - UCLA ...

UCLA OFFICE OF ENVIRONMENT, HEALTH & SAFETY
AMERICAN RED CROSS FIRST AID & CPR
TRAINING ENROLLMENT FORM
Name: _____________________________________________ UCLA I.D.#: _______________________ Ext: ________________
Email: ___________________________________________ Dept: ____________________________________________________
Address: _________________________________________________________________ Campus Mail Code: _______________
Acceptable Methods of Payment: Personal Check (payable to UC Regents): Department Recharge:
Supervisor or Budget Officer Approval: _______________________________________ Dept Code: ____________
FAU (13 Digit Full Accounting Unit): _________________________________________ Recharge ID: __________
Department Contact: __________________________________________________ Extension: _____________
Please indicate which date you would like to attend:
Standard First Aid & Adult CPR
(w/AED)
Date: __________________________
Full Course ($52.00):
Adult CPR ($40.00):
Community First Aid & Safety
(w/AED)
Date: _________________________
Full Course ($60.00):
Adult, Child &
Infant CPR ($50.00):
Please return this form by fax: (310) 825-7076 or campus mail to:
UCLA Office of Environment, Health & Safety
501 Westwood Plaza, 4 th floor
Los Angeles, CA 90095-1605
Strathmore Bldg. MC 160508
CPR Training Only
Date: _________________________
Full Course ($50.00):
If you are paying by personal check you may bring your payment the day of class or mail/drop-off to the address above.
For general information, questions, or to request a specialized training session for your department, please contact Cindy
Loomis at loomisc@ehs.ucla.edu or by calling (310) 206-8680.
3/11/2009 1:29:00 PM