Scribd
Upload
66 views3 pages

Matthew W. Adair: AHA TC Affiliate Instructor Roster

Uploaded by

M A
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as XLS, PDF, TXT or read online on Scribd
66 views3 pages

Matthew W. Adair: AHA TC Affiliate Instructor Roster

Uploaded by

M A
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as XLS, PDF, TXT or read online on Scribd
You are on page 1/ 3

AHA TC Affiliate Instructor Roster

*This Roster is used for An Instructor who is affiliated with


Faithful Guardian Train Center but is not an Employee of FGTC
Email: [email protected] Webisite: www.faithguardian.com

HEALTHCARE Courses HEARTSAVER Courses Friends & Family Courses Courses Information Number
Computer or Online Course ( check here ): ________ Manikins
Healthcare Provider X Adult General Public Courses
ACLS Child CPR in Schools Course Date: JAN 17,2020 Adult: 4
ACLS EP Infant AED Total Course Hours:
PALS AED Adult Start Time: 17:00 End Time: 21:00 Child: 4
Physician available for Heartsaver First Aid Child
ACLS / ACLS EP / PALS Enviromental Infant Total Participants Complete: 12 Infant: 3
Emergencies First Aid
Course Location: OMS OFFICE AED: 4

Name of Instructor(s) CTC Instructor Email Instructor Number Instructor Phone


( Print Information ) (Found on AHA Inst. Network) ( Best Contact Number )
Lead Instructor
1 Matthew W Adair FGTC [email protected] 4130169710 (770) 940-2902

2 FGTC

3 FGTC

4 FGTC

5 FGTC

6 FGTC

Mail Card to -Bill to: TCF / RF Contact Information ( send monitor form )
Only fill out if not same as Lead Instructor Only fill out if monitoring / mentorintg instrutors Manikins Decontaminated By:
Name: Name:
Address: Address: Matthew W. Adair
City, St Zip: Villa Rica Georgia 30180 City, St Zip: Instructor Signature
Phone# Phone#
w W. Adair

You might also like