Program

Welcome to Flatline Registration Please take a few moments to review the registration policies

Registration Date - Today

Student Name

E-mail

Please confirm your e-mail address

Phone

Address

City

Province

Postcode

Register ing Additional Students into the Same Program Please include Student Full Name, email address if available. Or Click "Next" to continue

Select First Aid Program

Select Preferred Date for Program - Confirm this is the correct date of your program.

Do you require BC First Aid?

Do you have a current First Aid Certificate? If No or Not Sure click Next to Continue If Yes - Please provide details below if information is available.

Previous -First Aid Level

Course Provider

Certificate Number

Expiry Date

Not a Corporate Click Next to ByPass

Corporate Client If "No" click Next to continue - If "Yes" please complete details

Purchase Order Number - If Required

Company

Company Phone

Company Contact

Mobile Phone

Contact Email

Please confirm your e-mail address

Would you prefer to pay with an E-Transfer? An email will be sent shortly with the E-Transfer Details - or complete registration, submit and call the Registration Desk at 403-571-7655.

CREDIT CARD DETAILS Name on Card

Credit Card Type NOTE - We are unable to process some VISA debit Cards. We will contact you if there is an issue.

Credit Card Number

Expiry Mon

Expiry Year

CC - CVV

By completing and submitting this form I give my consent to the Flatline to complete registration process, to contact me by email, text,. phone or other method as required to confirm my details. i understand that all registrations must be paid in order for a confirmation to be sent and to receive a program certifcation. I agree to abide by all policies and procedures necesary for the process of registrationand scheduling of training and classroom requiremets for courses I have applied for.

I agree to review the training and registration policies outlined on the website.

Program

Course Details - Registration & Certification Details

Corporate Client

Payment Details