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2. First Name*
3. Last Name*
5. Address1*
7. City*
8. State*
9. Zip*
11. Email Address*
12. Phone Number*
16. Class Information

    This CPR/AED class will be held on Thursday, March 19th from 5:30pm to 9:30pm.  This four hour class will be held at Fire Station 1 located at: 

    415 4th St NW in East Grand Forks

    The fee for the class is $75.  This fee can be paid over the phone by calling the Administration Office at (218) 773-2483 or a check/cash can be brought to the class made out to the City of East Grand Forks. 

18. Payment Option*
    -- Select One --Calling Administration OfficeBringing a Check to the Class

    Please choose which option you will be paying for the class.  All phone payments will be reported to the Fire Department.

22. E-signature of Applicant*
23. Date*
    Date
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25. 1. Receive an email copy of this form.
26. Email address

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