NCBH/School of Medicine/WFBH Community Physicians Employee
BLS/ACLS Combined Update Registration Form

Participants must present a copy of their expiring ACLS card. In order to attend a refresher class, you must have taken ACLS within the last five years. If class taken outside Life Support Education, fax a copy of the card to 336-716-5927 with note stating which class you registered for.


Are you an NCBH, School of Medicine, or
WFBH Community Physicians Employee
Date to Attend                             
Last Name
First Name
Middle Initial
Employee ID
Credentials (MD, RN, etc)
Phone Number
Alternate Phone Number
Department Name
Department Number
E-mail Address
Re-Enter E-Mail Address

By choosing “yes,” I understand that I must complete the ACLS precourse assessment, score at least an 80%, print the results, and bring it with me to class. 

To access the precourse assessment, go to and enter this code: acls15. 

I understand that if I do not bring the certificate with me, I will not be allowed to take the class.

                 YES, I have read the above statement.

We will notify you of your acceptance into the class through the email address you provided.

Quick Reference

Life Support Education
Mikell White

Phone 336-716-2800
Fax 336-716-5927

Contact Mikell

Rebecca Gregory

Phone 336-716-2888
Fax 336-716-5927

Contact Rebecca


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Disclaimer: The information on this website is for general informational purposes only and SHOULD NOT be relied upon as a substitute for sound professional medical advice, evaluation or care from your physician or other qualified health care provider.

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