BLS Update Registration Form 

NCBH/School of Medicine/WFBH Community Physicians Employee 

NOTE: Find the date you would like to attend on the left, and pick a time to attend that class on the right. Please choose only ONE date and time to attend.


 Date to Attend Time to Attend
May 2, 2016  
May 20, 2016  
May 31, 2016  
June 3, 2016       
June 15, 2016     
June 30, 2016       
July 5, 2016     
July 15, 2016  
July 26, 2016     
August 2, 2016     
August 11, 2016       
August 29, 2016  


Are you an NCBH, School of Medicine, or
WFBH Community Physicians Employee?
*Note to ALL School of Medicine/Health Sciences
and WFBH Community Physicians Employees:
Please send a signed and completed authorization form to Life Support Education
BEFORE the scheduled day of class. This form must be completed by the
administrative person in your area and allows us to bill your department for the course.
This is a requirement to attend class. You can find this form on the Life Support Education
website under FORMS.
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
We will notify you of your acceptance into the class through the e-mail 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.