Complete this form to request an appointment for the AHA ACLS Instructor Class.

DO NOT SUBMIT THIS FORM IF YOU ARE NOT READY TO SCHEDULE AND PAY FOR YOUR CLASS!

ACLS Instructor Request Form

Name(Required)
Email(Required)
Address(Required)
Accepted file types: jpg, pdf, png, Max. file size: 32 MB.
I confirm that I am at least 18 years old.(Required)
I understand I will be required to align with Mid-Florida CPR as my Primary Training Center.(Required)
I understand that my alignment with your Training Center does not represent affiliation as an employee, independent contractor, partner, licensee, or franchisee, and I am responsible for the maintenance/purchase of all training equipment.(Required)
I understand that all fees paid for the instructor course are NON-REFUNDABLE.(Required)
I confirm that by submitting this form, I am ready to complete the $575 payment today for the AHA ACLS Instructor class. If you are not ready to complete the payment, do not submit this form. We do not reserve dates or hold seats for classes until they are paid for.(Required)