CPR Registration -Register in 3 easy steps

1. Select the date that you would like to attend and complete the form below.

2. Print this page, enclose
payment to "NIEC".

3. Mail form & payment to:
     P.O. BOX 11176
     Philadelphia, PA 19136
IMPORTANT: Please see the descriptions of each course on the CPR page to be sure
that you are registering for the correct course.

HeartSaver CPR (Adult and/or pediatric)

Fees are:    $75.00 without book or mask
                  $90.00 with book and mask                                    (Circle One)
                  $82.50 with book only
                  $82.50 with mask only

Please choose a date:

Health Care Provider (approx. 4-5 hours for full course, 3 hours for recert)

  Fees are:      $115.00 including book and pocket mask
$105.00 with book only                                      (Circle One)
$105.00 with pocket mask only
                      $95.00 if neither book or pocket mask is needed
                     (The pocket mask is required. You may bring your own with you).

 Please choose a date:



City: State:   Zip:

Phone (Day):   Evening:

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