CPR/BLS CE

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CPR/BLS CE Registration

What is your membership type?(Required)

TCDS Member

CDA Member (not TCDS)

Non-Member

TCDS Student

Name(Required)

First Last

Email(Required)

Phone(Required)

License #(Required)

ADA#

AGD#

Local Society(Required)

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Year(Required)

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TCDS Member Price

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CDA Price

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Non-Member Price

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Student Price

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TCDS/CDA Member Guest Price

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Non-Member Guest Price

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Student Guest Price

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TCDS/CDA Member Guest Price

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Attending Value (1)

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Attending Value (0)

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Final Attending Value

Will you be attending The CE?(Required)

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Number of guests(Required)

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Total Attendees

Total(Required)

Price: $0.00

Guest 1 Information

Guest 1: Name

First Last

Email

Position

License #

Guest 2 Information

Guest 2: Name

First Last

Email

Position

License #

Guest 3 Information

Guest 3: Name

First Last

Email

Position

License #

Guest 4 Information

Guest 4: Name

First Last

Email

Position

License #

Guest 5 Information

Guest 5: Name

First Last

Email

Position

License #

Guest 6 Information

Guest 6: Name

First Last

Email

Position

License #

Credit Card(Required)

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Expiration Date

Security Code Cardholder Name

Post expires at 1:24pm on Thursday September 18th, 2025