Key Medical Resources, Inc



KEY MEDICAL RESOURCES, INC. Registration From

For Self-Study Modules, please submit $2 per contact hour payment when the answer sheet is returned.

Ways to Register for Classes: Any method is acceptable

• Fax to: (951) 739-0378

• Email to: Educate100@

• At the door – please call before coming to be sure there are enough persons for the course.

For fax or email registrations, payment will be at the door. Please carefully print all data.

|Name: |First |

| | |

| |Last |

|Email: | |

|Telephone: Mobile preferred |( ) |

|License # & type: i.e. RN 12345 | |

|Class Name | |

|Class Date | |

|Class Location | |

Payment is at the door – Check, credit card or cash please.

For American Heart Association Renewal classes, the book will need to be purchased BEFORE the class and brought with you to the course.

All AHAbooks contain pre-study information.

Questions? Please call Terry Rudd at (951) 520-3116 or email Educate100@

For Credit Card Payments: Credit card will indicate Key Medical Resources, Inc.

If American Express is used, credit card will indicate Rudd & Wellins Enterprises.

FAX all credit card payments to 951 739-0378. No refunds unless class canceled.

For Self-Study Modules, please submit $2 per contact hour payment when the answer sheet is returned.

|Name on Card | |Credit Card Type |Visa, Mastercard, Amex |

|Address on Bill | |Credit Card Number | |

|City | |Expiration Date | |

|Zip Code | |3 Digit Code on Back | |

|Amount charged | |Signature | |

|SIGNATURE CONFIRMS AUTHORIZATION, FOR Key Medical Resources or Rudd & Wellins Enterprises (AMEX)TO DEBIT CREDIT CARD |

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