havoc usa
registration form
Use this form to register for all available courses, events, and services. Incomplete forms may result in your registration being deleted and/or your services being delayed.
First Name
Last Name
Phone
E-mail
Company or Organization
Training Courses
a Adult Only CPR, AED, First Aid, BBP Certification (NEW Certification) b Adult Only CPR, AED, First Aid, BBP Certification (RENEW Certification) c Adult Only CPR, AED, & First Aid Certification (NEW Certification) d Adult Only CPR, AED, & First Aid Certification (RENEW Certification) e Adult Only CPR, AED Certification (NEW Certification) f Adult Only CPR, AED Certification (RENEW Certification) g Adult/Child CPR, AED, First Aid, BBP Certification (NEW Certification) h Adult/Child CPR, AED, First Aid, BBP Certification (RENEW Certification) i Adult/Child CPR, AED, First Aid Certification (NEW Certification) j Adult/Child CPR, AED, First Aid Certification (RENEW Certification) k Adult/Child CPR, AED Certification (NEW Certification) l Adult/Child CPR, AED Certification (RENEW Certification) m Adult/Child/Infant CPR, AED, First Aid, BBP Certification (NEW Certification) n Adult/Child/Infant CPR, AED, First Aid, BBP Certification (RENEW Certification) o Adult/Child/Infant CPR, AED, First Aid Certification (NEW Certification) p Adult/Child/Infant CPR, AED, First Aid Certification (RENEW Certification) q Adult/Child/Infant CPR, AED Certification (NEW Certification) r Adult/Child/Infant CPR, AED Certification (RENEW Certification) s Adult/Child First Aid, BBP Certification (NEW Certification) t Adult/Child First Aid, BBP Certification (RENEW Certification) u Adult/Child/Infant First Aid, BBP Certification (NEW Certification) v Adult/Child/Infant First Aid, BBP Certification (RENEW Certification) AVERT Active Shooter Training
Events (None at this time)
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Services
a AED/First Aid Kit Inspection b Emergency Action Plan Consultation c Facility Security plan Consultation d New AED/First Aid Kit Site Survey e Emergency Signage Design and Print f Emergency Action Plan Design and Build g Facility Security Plan Design and Build h AED/First Aid Kit Installation
Number of Participants
Individual or Self Group (2-7 people) Specify additional names in comments Group (8-12 people) Specify additional names in comments Group (13+ people)Specify names in comments. Will not be on same day.
First Desired Date (We will do our best to accommodate your request)
Alternate Date
Location
On my site At instructor's site Other (Please specify details in comments section below)
Start Time Desired (Most courses require 8 hours of instruction)
I want to purchase the following equipment:
TACPAC Emergency Kit
AED Wall Mounted Box
AED
Additional Comments
I agree to the Terms & Conditions and Privacy Policy
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