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2. Narragansett Fire / Rescue Department

   Group CPR Class Request From

4. Name of the group or organization requesting?*
6. Contact Person*
7. Phone Number*
9. Contact Person Email Address*
11. Anticipated number of people in the class?*
12. What is your preferred day and time for the class?

    1. Weekday Morning
    2. Weekday Afternoon
    3. Weekday Night
    4. Weekend Morning
    5. Weekend Afternoon
    6. Weekend Night
14. Do you have a facility to hold the class?

    1. Yes
    2. No
16. if Yes, what is the address of the facility?
18. Comments:
20. Link to the course being offered

    CPR Class Information

Leave This Blank:


22. 1. Receive an email copy of this form.
23. Email address

    This field is not part of the form submission.

24. Submit Submit and Print

* indicates a required field