Pre-registration / Request for more information form

If you would like to:

• Request information about one of our courses
• Pre-register for a specific course
• Be added to our mailing list to receive schedule updates

Simply fill out the form below and click on the SUBMIT button

	Company Name (if corporate inquiry):
*	Your name (first and last):
	Address (line 1):
	Address (line 2):
	City:
	Province:
	Postal Code:
*	Phone Number:
	Fax Number:
	Cell / Pager:
	Purchase Order # (if applicable):
*	Email Address:
Note: Fields marked with an asterisk are required fields. You will not be able to select a particular date, only the month. If the course you have an interest in does not appear on the list, please use the comment table below to make your interest known.
	Course of interest (choose one):	Scroll Down -------- WorkSafeBC Courses --------- Occupational First Aid Level 1 Occupational First Aid Level 2 (1 Week) Occupational First Aid Level 2 (5 Week) Occupational First Aid Level 3 (2 Week) Occupational First Aid Level 3 (5 Week) Occupational First Aid Level 3 PRO Transportation Endorsement Occupational First Aid Instructor Training WorkSafe Safety Courses --------- Red Cross Courses ---------- CPR & AED - All Levels Emergency First Aid / CPR "C" with AED Standard First Aid / CPR "C" with AED Child Care First Aid (Includes CPR "B" with AED) First Responder Emergency Medical Responder Red Cross Instructor Training
	When would you like to take this course?:	Scroll Down January February March April May June July August September October November December
Please select all of the following choices that apply:   I require information about a course   I am pre-registering for the course indicated above   Please add me to your mailing list
If you have any additional comments or questions please enter them below:
If you are having problems reading the two words, click the button above to get two new words.