Employee PALS Update Registration Form

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 a Cornerstone, Wilkes Regional, School of Medicine,  
NCBH, Community Physicians Employee or Travel Nurse?
   
Date to Attend  
Last Name
First Name
Middle Initial
Employee ID
Credentials (MD, RN, etc)
Phone Number
Alternate Phone Number
Department Name
E-mail Address
   

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
Mikell White

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

Contact Mikell
miwhite@wakehealth.edu

Rebecca Gregory

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

Contact Rebecca
rbgregor@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.

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