Registration for Virtual Epi-Pen & Med Admin Training First Name * Last Name * Email * Town/Organization * Phone * Attendee 1 * Attendee 1 Course & Date Selection * (Select/Deselect All) Thursday, June 12, 2025 Tuesday, June 17, 2025 Epi Pen ($45): 6:00 - 7:00 PM Med Admin ($50): 7:00 - 8:30 PM BOTH ($63): 6:00 - 8:30 PM Attendee 2 Attendee 2 Course & Date Selection (Select/Deselect All) Thursday, June 12, 2025 Tuesday, June 17, 2025 Epi Pen ($45): 6:00 - 7:00 PM Med Admin ($50): 7:00 - 8:30 PM BOTH ($63): 6:00 - 8:30 PM Attendee 3 Attendee 3 Course & Date Selection (Select/Deselect All) Thursday, June 12, 2025 Tuesday, June 17, 2025 Epi Pen ($45): 6:00 - 7:00 PM Med Admin ($50): 7:00 - 8:30 PM BOTH ($63): 6:00 - 8:30 PM Attendee 4 Attendee 4 Course & Date Selection (Select/Deselect All) Thursday, June 12, 2025 Tuesday, June 17, 2025 Epi Pen ($45): 6:00 - 7:00 PM Med Admin ($50): 7:00 - 8:30 PM BOTH ($63): 6:00 - 8:30 Attendee 5 Attendee 5 Course & Date Selection (Select/Deselect All) Thursday, June 12, 2025 Tuesday, June 17, 2025 Epi Pen ($45): 6:00 - 7:00 PM Med Admin ($50): 7:00 - 8:30 PM BOTH ($63): 6:00 - 8:30 PM Attendee 6 Attendee 6 Course & Date Selection (Select/Deselect All) Thursday, June 12, 2025 Tuesday, June 17, 2025 Epi Pen ($45): 6:00 - 7:00 PM Med Admin ($50): 7:00 - 8:30 PM BOTH ($63): 6:00 - 8:30 PM Attendee 7 Attendee 7 Course & Date Selection (Select/Deselect All) Thursday, June 12, 2025 Tuesday, June 17, 2025 Epi Pen ($45): 6:00 - 7:00 PM Med Admin ($50): 7:00 - 8:30 PM BOTH ($63): 6:00 - 8:30 PM Attendee 8 Attendee 8 Course & Date Selection (Select/Deselect All) Thursday, June 12, 2025 Tuesday, June 17, 2025 Epi Pen ($45): 6:00 - 7:00 PM Med Admin ($50): 7:00 - 8:30 PM BOTH ($63): 6:00 - 8:30 PM Attendee 9 Attendee 9 Course & Date Selection (Select/Deselect All) Thursday, June 12, 2025 Tuesday, June 17, 2025 Epi Pen ($45): 6:00 - 7:00 PM Med Admin ($50): 7:00 - 8:30 PM BOTH ($63): 6:00 - 8:30 PM Attendee 10 *if more than 10 attendees, submit additional forms Attendee 10 Course & Date Selection (Select/Deselect All) Thursday, June 12, 2025 Tuesday, June 17, 2025 Epi Pen ($45): 6:00 - 7:00 PM Med Admin ($50): 7:00 - 8:30 PM BOTH ($63): 6:00 - 8:30 PM Payment Method * Send Invoice Credit Card (CRPA will email an invoice that is payable online) By selecting "Yes" below, I agree that: No refunds will be issued for cancellations made after 5/29/25. Cancellations must be received in writing via email to [email protected] or [email protected]. Should CRPA cancel the event or the event be canceled due to a government shutdown (force majeure) your choice of either a refund or a credit for the 2026 event will be issued. Please note, all refunds will be issued via check, regardless of initial method of payment. * Yes No Are you human?
