HEALTH EDUCATORS, INC



hEALTH EDUCATORS, INC.

2008 Healthcare Provider RENEWAL CPR – Registration Form (Kindred employees only)

PLEASE PRINT

|PARTICIPANT Information |

|First Name | |Last | |M.I. | |Date | |

|Street Address | |Apartment/Unit # | |

|City | |State | |ZIP | |

|Home Phone | |Work Phone | |

|Cell Number | |Fax Number | |

|Email address | |

|Hospital |Kindred Hospital |Department | |

|Job Title |MD |PA |RN |RT |LPN |Paramedic |Other: |

| |

|Class Information |

|Time |All classes are scheduled to last for 4 hours |Place |NG = Northgate Centre , 8010 Staples Mill Rd. |

| |9 a.m. to 1 p.m. | |SMH = St. Mary’s Hospital |

| |1 p.m. to 5 p.m. | |MRMC = Memorial Regional Medical Center |

| |6 p.m. to 10 p.m. | |RCH = Richmond Community Hospital |

| | | |SFMC = St. Francis Medical Center |

|Dates |**See attached** |

|1st Choice: | |2nd Choice: | |

|Book: **NOT included in the price of the course** |

|Order your book from – or 1-800-367-0382 - BLS for Healthcare Provider (book code: 80-1010) |

| |

Please fax or mail your request to:

(Confirmation will be faxed or emailed to you within 48 hours - if you don’t receive a confirmation please call our office)

Health Educators, Inc., 8010 Staples Mill Rd., Richmond, VA 23228

Phone: (804) 553-0460; Fax: (804) 553-0463

Email: healtheducators@ Website:

|January 8 |9 am |NG | | |April 24 |6 pm |NG | | |September 9 |9 am |NG | | |January 11 |9 am |MRMC | | |May 9 |9 am |MRMC | | |September 12 |9 am |MRMC | | |January 11 |1 pm |MRMC | | |May 9 |1 pm |MRMC | | |September 12 |1 pm |MRMC | | |January 12 |9 am |SMH | | |May 10 |9 am |SMH | | |September 13 |9 am |SMH | | |January 16 |1 pm |NG | | |May 13 |9 am |NG | | |September 17 |1 pm |NG | | |January 24 |6 pm |NG | | |May 21 |1 pm |NG | | |September 25 |6 pm |NG | | |January 29 |9 am |RCH | | |May 22 |6 pm |NG | | |October 1 |9 am |SFMC | | |January 29 |1 pm |RCH | | |June 4 |9 am |SFMC | | |October 1 |1 pm |SFMC | | |February 6 |9 am |SFMC | | |June 4 |1 pm |SFMC | | |October 7 |9 am |NG | | |February 6 |1 pm |SFMC | | |June 10 |9 am |NG | | |October 10 |9 am |MRMC | | |February 8 |9 am |MRMC | | |June 13 |9 am |MRMC | | |October 10 |1 pm |MRMC | | |February 8 |1 pm |MRMC | | |June 13 |1 pm |MRMC | | |October 11 |9 am |SMH | | |February 9 |9 am |SMH | | |June 14 |9 am |SMH | | |October 15 |1 pm |NG | | |February 12 |9 am |NG | | |June 18 |1 pm |NG | | |October 23 |6 pm |NG | | |February 20 |1 pm |NG | | |June 26 |6 pm |NG | | |October 30 |9 am |RCH | | |February 28 |6 pm |NG | | |July 8 |9 am |NG | | |October 30 |1 pm |RCH | | |March 8 |9 am |SMH | | |July 11 |9 am |MRMC | | |November 4 |9 am |NG | | |March 11 |9 am |NG | | |July 11 |1 pm |MRMC | | |November 14 |9 am |MRMC | | |March 14 |9 am |MRMC | | |July 12 |9 am |SMH | | |November 14 |1 pm |MRMC | | |March 14 |1 pm |MRMC | | |July 16 |1 pm |NG | | |November 19 |1 pm |NG | | |March 19 |1 pm |NG | | |July 24 |6 pm |NG | | |November 20 |6 pm |NG | | |March 27 |6 pm |NG | | |July 30 |9 am |RCH | | |December 9 |9 am |NG | | |April 2 |9 am |SFMC | | |July 30 |1 pm |RCH | | |December 12 |9 am |MRMC | | |April 2 |1 pm |SFMC | | |August 6 |9 am |SFMC | | |December 12 |1 pm |MRMC | | |April 8 |9 am |NG | | |August 6 |1 pm |SFMC | | |December 13 |9 am |SMH | | |April 11 |9 am |MRMC | | |August 8 |9 am |MRMC | | |December 17 |1 pm |NG | | |April 11 |1 pm |MRMC | | |August 8 |1 pm |MRMC | | |December 18 |6 pm |NG | | |April 12 |9 am |SMH | | |August 9 |9 am |SMH | | | | | | | |April 15 |9 am |RCH | | |August 12 |9 am |NG | | | | | | | |April 15 |1 pm |RCH | | |August 20 |1 pm |NG | | | | | | | |April 16 |1 pm |NG | | |August 28 |6 pm |NG | | | | | | |

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