Incoming House Officers

 

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, please make a note that you are an incoming house officer.

Fax:
336-716-5927

E-mail: jpettit@wakehealth.edu

Address:
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 Program
Primary Phone Number
E-Mail
*Please make sure your e-mail address is correct. All confirmations will be sent to your e-mail address.
   
Address
City
State
Zip Code
*Please be sure that the address you list above will be the address that you would like for us to send textbooks to if you are registering for a class that includes a book.
 
   
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.
   
   

 E-Learning 

 
 
   

BLS (book will be online)

Fee: $25

 
  
   

ACLS (book will be online) 
In order to attend ACLS, you must be current in BLS or scheduled for a BLS class.

Fee: $110

 
      
   

PALS (book will be online)
In order to attend PALS, you must be current in BLS or scheduled for a BLS class.

Fee: $110

 
      
   

NRP (book is included in the fee for the course and will be sent once payment is received)
(Written exam is online and must be taken prior to course

Fee: $70 

 
     
   
 
   

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
Tiffany Loggins
For BLS, ACLS, & ITLS Questions

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

Contact Tiffany
tloggins@wakehealth.edu

Jill Pettit
For PALS, NRP, ENPC, TNCC, PITLS, & E-Learning Questions

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

Contact Jill
jpettit@wakehealth.edu

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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.