TOWN OF EAST FISHKILL RECREATION DEPARTMENT
AED/CPR TRAINING REGISTRATION FORM
November 12, 2011
Saturday
8:00am – 12:00pm
Place: East Fishkill Fire District Training Facility
2502 Route 52, Hopewell Junction, NY 12533
Cost: Free to Town of East Fishkill Residents and Town Employees
Limited to the first 25 registrants - $30.00 to others
Description: 2 Year Certification - American Heart Association Heart Saver AED Course
CPR, Choking, and How to Operate an Automatic External Defibrillator (AED)
Registration Deadline: Please return this completed registration form by via
Fax, Mail, Email, or in Person to:
Town of East Fishkill Recreation Department.
330 Route 376, Hopewell Junction, NY 12533
Phone 845-226-8395 Fax 845-226-1924 Email: recreation1@eastfishkillny.org
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Name: _________________________________________________________
Address: _______________________________________________________
Phone: ______________________ Email ___________________________
Affiliation (complete one) □ Town Employee
Department __________________________
□ Town League
League Name ______________________
Position ______________________
(example: Coach, Manager, Parent, etc.)
□ Other _____________________________
(example: Resident)
AED/CPR Training Class Offered