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<div id=”mc_embed_signup”>
<form action=”https://pthcedu.us19.list-manage.com/subscribe/post?u=5bb07f02163370b78988009b6&id=d94eb9238e” method=”post” id=”mc-embedded-subscribe-form” name=”mc-embedded-subscribe-form” class=”validate” target=”_blank” novalidate>
<div id=”mc_embed_signup_scroll”>
<h2>Subscribe to our mailing list</h2>
<div class=”indicates-required”><span class=”asterisk”>*</span> indicates required</div>
<div class=”mc-field-group”>
<label for=”mce-EMAIL”>Email Address <span class=”asterisk”>*</span>
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<input type=”email” value=”” name=”EMAIL” class=”required email” id=”mce-EMAIL”>
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<label for=”mce-FNAME”>First Name </label>
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<label for=”mce-LNAME”>Last Name </label>
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<div class=”mc-field-group”>
<label for=”mce-MMERGE6″>I’m Most Interested In? </label>
<select name=”MMERGE6″ class=”” id=”mce-MMERGE6″>
<option value=””></option>
<option value=”American Heart Association Courses”>American Heart Association Courses</option>
<option value=”Nurse Assistant Training”>Nurse Assistant Training</option>
<option value=”Patient Care Tech”>Patient Care Tech</option>
<option value=”Continuing Education Courses”>Continuing Education Courses</option>
<option value=”Nurse Refresher Course”>Nurse Refresher Course</option>
</select>
</div>
<div id=”mce-responses” class=”clear”>
<div class=”response” id=”mce-error-response” style=”display:none”></div>
<div class=”response” id=”mce-success-response” style=”display:none”></div>
</div> <!– real people should not fill this in and expect good things – do not remove this or risk form bot signups–>
<div style=”position: absolute; left: -5000px;” aria-hidden=”true”><input type=”text” name=”b_5bb07f02163370b78988009b6_d94eb9238e” tabindex=”-1″ value=””></div>
<div class=”clear”><input type=”submit” value=”Subscribe” name=”subscribe” id=”mc-embedded-subscribe” class=”button”></div>
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