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

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

BLS 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 confirm that I am not currently aligned with any other Training Center on the AHA Instructor Network.(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 all fees paid for the AHA instructor course are NON-REFUNDABLE.(Required)
I confirm that by submitting this form, I am ready to complete the $499 payment today for the AHA BLS Instructor class. If you are not ready to complete the payment today, do not submit this form. We do not reserve dates or hold seats for classes until they are paid for.(Required)