PLEASE Read Before Registering:
-All participants (NOT including 4th Year WFU Med Students) need to complete sections 1, 2, and 4
-4th Year WFU Med Students need to complete sections 1 and 3 only

BLS, ACLS, and PALS E-Learning Skills Check-Off Registration Form

Section 1 (ALL Participants)
First Name  
Middle Initial  
Last Name  
Credentials (RN, EMT-P, MD, etc)  
Phone Number  
Are you an NCBH or WFHS/School of Medicine Employee?


   Employees: You must provide payment information to Life Support Education in order to receive an online access code.  This is a requirement to attend class.  There is no charge for online access code  as long as you attend your scheduled class.
IF you are an NCBH, WFUHS, or Community Physician Employee:
Employee ID (Required)
Will you need an online access code, or have you already completed the online portion?
(BLS for HealthCare Providers Online Part 1, HeartCode ACLS Part 1, or HeartCode PALS Part 1)
Section 2 (All Participants, EXCEPT for 4th Year WFU Med Students)
NOTE: 4th Year WFU Med Students do NOT need to complete this section
Which skills check-off do you need?
Check ALL that apply!

Please choose a date to attend your preferred classes
(If attending more than one, choose a date for each class)

NOTE: You can sign up for a BLS, ACLS, and PALS check-off in the same day if desired.  

ACLS (In order to attend ACLS, you must be current in BLS)  
PALS (In order to attend PALS, you must be current in BLS)  
Section 3 (4th Year Med Students ONLY)
May 11, 2016 (Med Student BLS and ACLS E-Learning Skills Check Off)
PLEASE NOTE: You must complete BOTH BLS AND ACLS in order to attend this check-off. 
The cost of the class is $150.00.

Section 4 (All Participants, EXCEPT for 4th Year WFU Med Students)
By choosing "yes," I understand that payment will be required BEFORE any online access codes can be issued. Once payment is received, we will email your code to you. If I am an NCBH, WFUHS, or Community Physician employee, I must submit credit card information to receive an online access code by contacting Life Support Education at 716-2800 or 336-716-2888. Once this code is emailed, I agree to attend class or be charged for the cost of this class.
To make payment arrangements, please call 336-716-2800 or 336-716-2888.  


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

Find a Doctor Ways to Give
Comprehensive Cancer Centers National Designation is RenewedMagnet Hospital RecognitionConsumer Choice2015 Best DoctorsJoint Commission Report

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.