Lost Card Replacement

Certified Emergency Training

AHA ACLS or AHA PALS

-Advanced Cardiac Life Support

-Pediatric Advanced Life Support

Replacement Card:

$15/per Card

Payment can be made via PayPal.

Alternative forms of payment can be arranged with representative per request on the form.

Which Class are you requesting a replacement Card or Certificate for?

Heartsaver CPR/AED

Heartsaver CPR/AED and First Aid

Heartsaver First Aid Only

Basic Life Saver (BLS)

Advanced Cardiac Life Support (ACLS)

Pediatric Advanced Life Support (PALS)

ECG/Pharmacology - (No Charge for Replacement Certificate of Completion)

Airway Management - (No Charge for Replacement Certificate of Completion)

Other (Please Specify Below)

Maiden Name or Shortened Name Card may be listed under:

Date Range of when class was taken (Best Guess for Month and Year - If date is known please enter the date in both boxes): *

Lost Card? Here's how to request a replacement!

Please Provide any Additional Information that may help us find your card:

AHA ECG/Pharmacology or Airway Management

Replacement Certificate of Completion:

No Charge

AHA BLS or AHA Heartsaver

Heartsaver CPR/AED and/or First Aid

Basic Life Support

Replacement Card:

$10/per Card

Payment can be made via PayPal.

Alternative forms of payment can be arranged with representative per request on the form.

You will receieve an email from one of our representatives within 24 - 72 Hours. You will be notified that your card will be mailed once we receive payment.

How do you plan to pay the replacement fee? *

On the Website via PayPal

Other

Other Class not Listed Above:

If you have lost or misplaced your card we ask that you fill out the form below with correct information to the best of your knowledge. We also need a mailing address that you can receive the card at. You will receive the card in the mail after payment has been received and all arrangements have been made. An AHA BLS or Heartsaver CPR/AED and/or First Aid replacement card costs $10. An ACLS or PALS Replacement card costs $15. Once the form has been submitted a representative will contact you for any additional information needed and to confirm your mailing address. The information is for us to find your name within our system, we keep records for up to 5 years after the course date. Remember your card is only valid for 2 years after the date it was issued! DO NOT SUBMIT PAYMENT UNTIL YOU CONFIRM WITH OUR REPS THAT YOU ACTUALLY TOOK YOUR COURSE WITH US AND IT IS NOT EXPIRED.

The Paypal links may not function properly on mobile devices, we are working with our provider to remedy the issue.

Any fraudulent card requests will be reported to the American Heart Association, the transaction is considered fraudulent if you have not attended any course and are requesting a card that you have not earned. You will be contacted by a representative to provide paperwork, if unable to your money will not be refunded. If your card has expired but you have taken the class it will not be considered fraudulent, your money will be refunded and you will not receive a new card, until you have attended your renewal course.

Mailing Address of where card should be shipped: *

Name: *

If training was attended at an on-site location. Where or with which employer did you attend this training?

Where did you attend your Course with Certified Emergency Training?: *

At the CET Training Site Location in Elk Grove Village

On-Site Training at an Employer/Club/Other Location

Replacement Card Request Form

Email: *

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