Registration Form You are registering for: Class NameClass DateDurationStart TimeLocationFree CPR Mask ($10 value) On the day of class, use your phone to check in on Facebook or Yelp and receive a free CPR mask. Certification You will receive the American Heart Association certification card on the day of the class. Valid 2 years. Student InformationMandatory Online Exam $140?YesNoNo means you have already purchased the ACLS online course from the AHA. Confirmation Notice & ReceiptEmail MeText MeBoth (recommended)Payment Information Visa, Mastercard or Discover. Cardholder does not need to be the student.-- Month --010203040506070809101112Expiration Month-- Year --20192020202120222023202420252026202720282029Expiration YearTotal $ RQI (Resuscitation Quality Improvement)Yes. I understand.Starting in March and April, we will be transitioning to using VAM (voice assisted manikin). During your skills testing, an instructor will not be present. You will perform your skills testing with the VAM and receive the official American Heart Association eCard on the day of your training. More info: www.bayareacpr.org/rqiACLS eLearning CertificateYes. I understand.If you have purchased the online course, we will send you the online exam link within 1 business day. You must complete this online course, print it out, and bring with you to the skills testing portion of the course. If you do not receive this link within 2 days, call us. If you have not purchased and completed the online course, you cannot attend. 4. Technical Specifications: Please use a desktop computer or laptop computer (not a phone or a tablet)Terms and ConditionsI agree to the terms and conditions. By clicking submit, you agree that your credit card will be charged and that there are absolutely no refunds for this online course. However, you can reschedule your appointment for no extra charge by contacting us by phone, chat or email. Please do not hit the back button or refresh as you will lose all your information.SubmitThank you!We will contact you soon.