Group/Company Name    

Contact Name              

Street                         

City                               Province      Postal Code

Phone                                               

Email                           

Type of Course              -- Select a course from this list -- Workplace Standard First Aid with CPR - A Workplace Emergency First Aid w/ CPR - A CPR / AED - Level A CPR / AED - Level B CPR / AED - Level C CPR / AED - Level HCP Standard Child Care First Aid w/ CPR - B Not sure - request for more information

Number of participants    

Course location                   --Choose your preferred location-- On site at client's location Vital CPR's North York site

Comments                    Enter any special requests, or questions here.