
Email: gina@iowacommunitycpr.com 
Register for Classes by:
- Mail (print this page, fill-out, and send with payment)
Payment accepted:
- Cash
- Check
For Cancellations:
The registration fee minus $20 handling fee is refundable up to three days prior to the class date. There will not be a refund granted for a no-show. Community CPR Classes, may cancel a class within three days of the class date if enrollment is insufficient. If this occurs, the participant will be informed of the cancellation and the entire registration fee will be refunded. Courses cancelled due to adverse weather conditions will be rescheduled. Participants will be granted a refund if there is a conflict with the new date.
PLEASE PRINT
First / Last Name________________________ Title / Position__________________
Home Address_____________________ City________ State____ Zip Code______
Employing Agency:________________ Business Phone:(____)__________________
Home Phone(____)__________ Cell Phone(____)_________ Email_____________
Name of Course____________________ Date__________ Time_______________
Charge for Class________ Coupon/Discount___________(include with payment)
Send registration with payment in-full to:
Community CPR Classes
(Ingersoll & 40th)
550 40th Street, Ste. A
Des Moines, Iowa 50312