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Name:
Address: City: State: Zip:
Phone: Email:
I am proud to report that I used the skills and knowledge that I learned in an American Red Cross class. Date that the training was provided: Class location:
Care was provided for: Bleeding Burn Cardiac Arrest Choking Head, Neck or Back Injury Heat Emergency Near Drowning Other
Please include a narrative of how you helped to save a life
All personal information will be kept confidential.