Application 2-Day WFAC: May 14-15, 2022
Your name: Phone number: email:
Street address:
You must be at least 14 years old to enroll.
Ages 14 through 17 may enroll with an enrolling adult.
[ ] Adult (21+ years old)
[ ] Young adult (18-20 years old)
[ ] Teen (14-17 years old, with a co-registering adult)
[ ] I have taken another WFA course of 16 hours or more in the past three years.
[ ] I am a healthcare professional -please specify (MD, RN, EMT, etc.)
[ ] I am an adult leader of Boy Scouts or Girl Scouts.
Is your submission complete?
Please use the following checklist for a complete application. For example, if you have enrolled in a CPR course, wait until you have the CPR card before submitting your application and fee.
[ ] Completed printout of this form
[ ] Copy of the CPR card (completed no more than 5 years prior to the date of the WFAC)
[ ] The Participation Release: read, signed and submitted electronically or by U.S. mail
[ ] A copy of your COVID-19 vaccination card with this application, electronically or by U.S. mail
Payment of the course fee in one of the following ways:
[ ] A mailed check for $160 made to WFAC
[ ] PayPal: Checking this box results in your receiving an invoice by email from WFAC.