HEALTH EDUCATORS, INC.
2008 Healthcare Provider Renewal CPR – Registration Form
PLEASE PRINT
PARTICIPANT INFORMATION
First Name
Last
M.I.
Street Address
Apartment/Unit #
City
State
Home Phone
Work Phone
Cell Number
Fax Number
Date
ZIP
Email address
Hospital or Company
Job Title
MD
RN
RT
LPN
Paramedic
Other:
CLASS INFORMATION
Time
All classes are scheduled to last for 4 hours
Place
NG = Northgate Centre , 8010 Staples Mill Rd.
9 a.m. to 1 p.m.
SMH = St. Mary’s Hospital
1 p.m. to 5 p.m.
MRMC = Memorial Regional Medical Center
6 p.m. to 10 p.m.
RCH = Richmond Community Hospital
SFMC = St. Francis Medical Center
Dates
**See attached**
1st Choice:
2nd Choice:
Book: **NOT included in the price of the course**
Order your book from – www.emsbooks.com or 1-800-367-0382 - BLS for Healthcare Provider (book code: 80-1010)
** Attach a copy of your current CPR card**
PAYMENT INFORMATION – PREPAYMENT IS REQUIRED
Course Fee: $55
Check enclosed:
Charge:
VISA
Make checks payable to: Health Educators Inc.
Mastercard
American Express
Discover
Account
Number:
Signature
Expiration Date:
Date
Please fax or mail your request to:
(Confirmation will be faxed or emailed to you within 48 hours - if you don’t receive a confirmation please call our office)
Health Educators, Inc., 8010 Staples Mill Rd., Richmond, VA 23228
Phone: (804) 553-0460; Fax: (804) 553-0463
Email: [email protected] Website: www.healtheducatorsinc.com
1|Page
/
January 8
9 am
NG
April 24
6 pm
NG
September 9
9 am
NG
January 11
9 am
MRMC
May 9
9 am
MRMC
September 12
9 am
MRMC
January 11
1 pm
MRMC
May 9
1 pm
MRMC
September 12
1 pm
MRMC
January 12
9 am
SMH
May 10
9 am
SMH
September 13
9 am
SMH
January 16
1 pm
NG
May 13
9 am
NG
September 17
1 pm
NG
January 24
6 pm
NG
May 21
1 pm
NG
September 25
6 pm
NG
January 29
9 am
RCH
May 22
6 pm
NG
October 1
9 am
SFMC
January 29
1 pm
RCH
June 4
9 am
SFMC
October 1
1 pm
SFMC
February 6
9 am
SFMC
June 4
1 pm
SFMC
October 7
9 am
NG
February 6
1 pm
SFMC
June 10
9 am
NG
October 10
9 am
MRMC
February 8
9 am
MRMC
June 13
9 am
MRMC
October 10
1 pm
MRMC
February 8
1 pm
MRMC
June 13
1 pm
MRMC
October 11
9 am
SMH
February 9
9 am
SMH
June 14
9 am
SMH
October 15
1 pm
NG
February 12
9 am
NG
June 18
1 pm
NG
October 23
6 pm
NG
February 20
1 pm
NG
June 26
6 pm
NG
October 30
9 am
RCH
February 28
6 pm
NG
July 8
9 am
NG
October 30
1 pm
RCH
March 8
9 am
SMH
July 11
9 am
MRMC
November 4
9 am
NG
March 11
9 am
NG
July 11
1 pm
MRMC
November 14
9 am
MRMC
March 14
9 am
MRMC
July 12
9 am
SMH
November 14
1 pm
MRMC
March 14
1 pm
MRMC
July 16
1 pm
NG
November 19
1 pm
NG
March 19
1 pm
NG
July 24
6 pm
NG
November 20
6 pm
NG
March 27
6 pm
NG
July 30
9 am
RCH
December 9
9 am
NG
April 2
9 am
SFMC
July 30
1 pm
RCH
December 12
9 am
MRMC
April 2
1 pm
SFMC
August 6
9 am
SFMC
December 12
1 pm
MRMC
April 8
9 am
NG
August 6
1 pm
SFMC
December 13
9 am
SMH
April 11
9 am
MRMC
August 8
9 am
MRMC
December 17
1 pm
NG
April 11
1 pm
MRMC
August 8
1 pm
MRMC
December 18
6 pm
NG
April 12
9 am
SMH
August 9
9 am
SMH
April 15
9 am
RCH
August 12
9 am
NG
April 15
1 pm
RCH
August 20
1 pm
NG
April 16
1 pm
NG
August 28
6 pm
NG
2|Page