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DAN Provider Course Roster

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					DAN Provider Course Roster
For use with Provider-level courses only. Complete a SEPARATE roster for each Training
Program and return it to DAN within 10 business days.

Certifying Instructor                                    DAN Instructor Number
Course Date                                       Course Location
City                                              State/Province


Certified Assistant                               DAN Instructor/Member Number
Certified Assistant                               DAN Instructor/Member Number

I verify that the students listed below have successfully completed the knowledge and skills
development sessions of the listed training program, in accordance with DAN Training Standards.
Instructor Signature__________________________________ Date ________________________

Training Program    (Select one)
    Scuba Oxygen First Aid                              REMO2
    Advanced Oxygen First Aid                           On-Site Neuro Provider
    AEDs for Scuba Diving                               Diving First Aid for Professional Divers
    Hazardous Marine Life Injuries                      Aquatic Oxygen First Aid
    DEMP with Advanced Oxygen                           AEDs for Aquatics
    DEMP w/oAdvanced Oxygen                             Dive FA for Nondivers
    Basic Life Support for Dive
Professionals

Course Participant List
Name                                 Member #___________
Mailing Address                                                         Email


Name                                 Member #___________
Mailing Address                                                         Email


Name                                 Member #___________
Mailing Address                                                         Email




                Mail: DAN Training Private BagX197, Halfway House 16855, RSA,
                  Fax: 086 512 9091, email: training@dansa.org
Revised 10/06
Name                               Member #___________
Mailing Address                                                    Email


Name                               Member #___________
Mailing Address                                                    Email


Name                               Member #___________
Mailing Address                                                    Email


Name                               Member #___________
Mailing Address                                                    Email


Name                               Member #___________
Mailing Address                                                    Email


Name                               Member #___________
Mailing Address                                                    Email


Name                               Member #___________
Mailing Address                                                    Email


Name                               Member #___________
Mailing Address                                                    Email




                Mail: DAN Training Private Bag X197 Halfway House 1685, RSA,
                  Fax: 086 512 9091, email: training@dansa.org
Revised 10/06

				
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