RECERTS
Registration Form | Sept 14 | Sunday
Name
*
First Name
Last Name
Age
*
Date of Birth:
*
-
Month
-
Day
Year
Date
Email
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Any additional Information
Please select:
National Lifeguard (8 AM - 12:00 PM)
Intermediate First Aid (1:00-5:00 PM)
Payment:
*
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National Lifeguart Recert
$
70.00
CAD
Quantity
1
2
3
4
5
6
7
8
9
10
Intermediate First Aid Recert
$
70.00
CAD
Quantity
1
2
3
4
5
6
7
8
9
10
NL & FA Recerts
$
110.00
CAD
Quantity
1
2
3
4
5
6
7
8
9
10
Credit Card
Submit
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