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Employee BLS Provider Registration Form


Are you a Cornerstone, Wilkes Regional, Travel Nurse,  
NCBH, WFUHS, or Community Physicians Employee?
Date to Attend Time to Attend
March 20, 2017  
March 21, 2017  
March 23, 2017  
April 10, 2017  
April 12, 2017  
April 24, 2017  
May 1, 2017  
May 15, 2017            
May 17, 2017  
May 25, 2017  
Last Name
First Name
Middle Initial
Employee ID
Credentials (MD, RN, etc)
Phone Number
Alternate Phone Number
Department Name
E-mail Address
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


3rd Floor South Building

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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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