Pre-registration / Request for more information form

Company Name (if corporate inquiry)

Your Full Name (required)

Address (line 1)

Address (line 2)

City

Province

Postal Code

Phone

Cell / Pager

Fax Number

Purchase Order # (if applicable)

Your Email (required)

Note: 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 section below to make your interest known.

Course of interest (choose one)
Select Course of Interest----- WorkSafeBC Courses -----Occupational First Aid Level 1Occupational First Aid Level 2 (1 Week)Occupational First Aid Level 2 part timeOccupational First Aid Level 3 (2 Week)Occupational First Aid Level 3 (part time)Occupational First Aid Level 3 PROTransportation EndorsementOccupational First Aid Instructor Training----- Red Cross Courses -----CPR & AED - All LevelsEmergency First Aid / CPR "C"Standard First Aid / CPR "C"Child Care First Aid

When would you like to take this course?
Select MonthJanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember

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