First Aid/CPR Course Registration

Student Registration Form

Fill out the form carefully for First Aid/CPR Course registration
Student Name

First NameLast Name
Company (If Maritime Industry)
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mobile Number
Format: (000) 000-0000.
Student E-mail
example@example.com
Birth Date

MonthDayYear
Did Someone Refer You To Chicago Maritime School?
Name
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Choose Course Start Date

First Aid/CPR/AED Course

USCG Approved - Required for USCG License.

$110.00

Total

Student Registration Form