ONLINE Course Registration Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Online Course Registration LADD First Aid Courses Select Your Course: *— Select Choice —Bloodborne Pathogens – $19.00Severe Bleed Care – $19.00CPR/AED ONLY** (No First Aid) – $49.00Complete First Aid/CPR/AED** – $69.00You may only select ONE course per registration Mailing Name Enter COURSE NOTE: This course DOES NOT include First Aid training ** This course is a HYBRID/BLENDED course, which requires BOTH the completion of the Online portion as well as the completion an IN-PERSON/HANDS-ON skills assessment test before an Instructor. HYBRID/BLENDED Courses are NOT CONSIDERED COMPLETE unless both components of the course are successfully completed. Student Name: *FirstLastStudent Email Address: *Student Telephone No.: *Telephone Number where we can call/text you.Student Mailing Address: *Address Line 1Address Line 2City— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeStudent Online Course Agreement As the student named in this application, I wish to enroll in an online course as offered by LADD Security Management Consultants, Inc. (hereinafter referred to as LADD). By submitting this application, I agree and understand that if the specified course is a certification or re-certification course, that it is my my sole obligation to fullfill the requirements of this course in order to receive certification or re-certification. I also understand that if the selected course is a hybrid/blended course, that I will be required to successfully complete both the online and in-person portions before being eligible to be certified or re-certified. I understand that I will have Thirty (30) Calendar days to complete the course that I wish to enroll in, starting from the date that I begin the course online. I also agree to hold LADD, its employees and agents, harmless from all liability in association with my enrollment and participation in the online course I have chosen. By entering my name as my electronic signature below, I agree to abide by the terms of this agreement, as well as LADD’s Refund Policy and Terms of Service. Enter Your Full Name as Your Electronic Signature: *Submit Payment