Alignment Inquiry "*" indicates required fields Name* First Last Email* Cell Phone*Work PhoneAre you located in one of the 50 United States (not including US territories)?* Yes No Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Are you a current Instructor?* Yes No Which agency(s) are you an instructor for?* AHA ARC HSI Select all that apply.Primary Organization/Business you teach for or own*If not applicable, put N/A.Business website (if applicable) Name of AHA Training Center you are currently aligned with (if applicable).We will keep all communication confidential.Which disciplines are you wanting to align?* Lay CPR BLS ACLS PALS Select all that apply.How long have you been teaching?* Less than 6 months 6 months to 2 years 2 years + How many students do you train on average per month?*Do you currently teach instructor classes?* Yes No How many instructors do you have affiliated under you?*How did you hear about us?*Select optionOnline SearchReferralYouTubeTell us why you are interested in transferring…*By checking this box, you agree to the below terms of service if you choose to work with Vitali Partners.* I agree.https://bit.ly/vitali-termsAfter you submit this form, you'll be redirected to watch a presentation about advantages and pricing when working with Vitali.* I understand EmailThis field is for validation purposes and should be left unchanged.
