Classroom Workshop Request Form

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Contact information

First name*

Middle name

Last name*

Email address*

Phone number

School information

School name*

Street address

City

State Please Select Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming

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Which workshop would you like us to present?* Please Select Health Career Presentation CPR in Schools Training Disaster Simulation/Triage Training/Emergency Preparedness Training Infection Control- gowning/gloving and proper hand-washing activities Nutrition Oral Health Activities College Prep Healthe Foundations Training- learn about preventable chronic disease as part of a healthcare team BLS/CPR Training/Certification- 4 hours total- maximum of 9 students- $50 per student First Aid Training/Certification- 3.5 hours total- maximum of 20 students- $50 per student Injections and Phlebotomy/Blood Draw Training- $25 to cover maximum of 15 students Animal Dissection- maximum 30 students- $13-26 per specimen (up to 3 students per specimen)

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