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Incoming House Officers / Fellows


Class Registration Form / Information Form 


If you have a current card in any of the disciplines below, please send a copy of the card to Life Support Education AND your Residency Coordinator BEFORE arrival. 

When sending cards, please make a note that you are an Incoming House Officer or Fellow.


Phone: 336-716-2800

Department of Life Support Education
Wake Forest Baptist Medical Center
Medical Center Blvd.
Winston-Salem, NC 27157


Please Complete the Form Below:  
First Name
Middle Initial
Last Name
Residency / Fellowship Program
Residency / Fellowship Program Coordinator 
Primary Phone Number
E-Mail Address
Confirm Email Address
Zip Code
Comments or Concerns  

 Choose which classes you would like to attend below.
If you already have a current card or if your residency program
does not require certification, please make note of this in the appropriate place.

 Online Learning

The following class dates are for skills evaluation portion of the class.
You will complete Part 1 online (test and scenarios) and print off your certificate of completion 
before you attend the class date below.  
HeartCode BLS

Fee:  $25


HeartCode ACLS 

In order to attend ACLS, you must be current in BLS or scheduled for a BLS class.

Fee: $130          


HeartCode PALS 

In order to attend PALS, you must be current in BLS or scheduled for a BLS class.

Fee: $130




NRP (book is included in the fee for the course and will be sent once payment is received)
(Exam is online and must be taken prior to course and must be purchased separately with instructions to be included in confirmation  

Fee: $100 




Traditional Classroom-Style Courses


Please complete this portion ONLY if you plan to take a traditional style PALS or ACLS class.

*Choose which classes you would like to attend.
Books are included in the fee for the PALS and ACLS Provider course.  






Quick Reference

Life Support Education
Kathy Nelson

Phone 336-716-2005
Fax 336-716-5927

Contact Kathy

Mikell White
Education Systems Specialist

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

Contact Mikell


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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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