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PALS Update Registration Form

This course is designed for participants who have previously completed PALS within the last five years (if previous PALS class taken outside Life Support Education fax a copy of the card to 336-716-5927).

Credits

The Wake Forest School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians and designates this live activity for a maximum of 5.0 AMA PRA Category 1 Credit(s)TM.

 

Wake Forest Baptist Medical Center Nursing Education is an Approved Provider of continuing nursing education by the North Carolina Nurses Association, an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation. Participation in this class provides 5 CEUs.

Fees:

Outside Student:  $200 (MD, PA) $100 (RN, EMT-P, etc.)

*Refunds will not be given if you are unable to attend this class. Please do not pay for a class unless you are prepared to attend the class date that you have scheduled. If unable to attend your scheduled date, we will gladly move you to a different day that will work with your schedule.

Employees: No Charge
PLEASE NOTE:
Participants must have a current AHA BLS Provider card and a copy of the expiring PALS card. In order to attend a refresher class, you must have taken PALS within the last five years. If classes were taken outside Life Support Education, fax a copy of the cards to 336-716-5927 with a note stating which class you registered for.

 

Are you an Employee?
  
If YES, are you a NCBH, WFUHS, Cornerstone, Wilkes, Community Physicians or Travel Nurse?
   
Date to Attend  
Last Name
First Name
Middle Initial
Employee ID
Credentials (MD, RN, etc)
Phone Number
If an Employee, Manager's Name (first and last)
E-mail Address
 
Method of Payment:

MD/PA $200 
 
NP/RN/EMT-P/etc. $100
 
  
If payment will be by check, please mail to: 

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

If paying in cash, please deliver in person to the Department of Life Support Education on the 3rd floor South Building. 

If paying by credit card, please call 336-716-2800 or stop by Life Support Education.  
 
   

By choosing “yes,” I understand that I must complete the PALS pre-course assessment, score at least an 80%, print the results, and bring it with me to class.

To access the pre-course assessment, go to www.heart.org/eccstudent and enter this code: PALS15.

I understand that if I do not bring the certificate with me, I will not be allowed to take the class.

               YES, I have read the above statement.

   
Comments/Concerns  
We will notify you of your acceptance into the class through the email address you provided.

Quick Reference

Life Support Education
Kathy Nelson
Manager

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

Contact Kathy
knelson@wakehealth.edu

Mikell White

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

Contact Mikell
miwhite@wakehealth.edu

 

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.

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