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City of Pembroke Pines | Online Form
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CPR Class Request Form (For groups of 5 or more)

  1. Type of Class *

  2. Location*

  3. Please provide a phone number or e-mail address where we may contact you.

  4. Classroom Requirements

    The classroom location must have the space to accommodate the amount of students requested. A DVD player and a view-able size television/monitor should be available to facilitate the instructor led course.

  5. Leave This Blank:

  6. This field is not part of the form submission.