NRP Registration Form 

NCBH/School of Medicine/WFBH Community Physicians Employee 

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

 

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.

   
Time to Attend Date to Attend
8am - 12pm
   
Last Name
First Name
Middle Initial
Employee ID
Credentials (MD, RN, etc)
Phone Number
Alternate Phone Number
Department Name
Department Number
E-mail Address
Comments/Concerns  
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
miwhite@wakehealth.edu

Chelsea Hollifield

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

Contact Chelsea
chollifi@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.