Pediatric Trauma Life Support Registration Form

 

Class Date
 
 
First Name  
Middle Initial  
Last Name  
Credentials (RN, EMT-P, MD, etc)  
Address  
City  
State  
Zip Code  
Phone Number  
E-Mail  
Are you an NCBH Employee?
NCBH Employees: $50
Non-NCBH Employees: $100
NOTE: A book is included in the fee for the course.
   
 
     
If you are an NCBH Employee:    
Employee ID (Required)  
     
If you are NOT an NCBH Employee:    
Last Four of Social (Required)  

Month and Day of Birthday (Required)

 
Place of Employment (Required)  
     
     


Books and study materials can be picked up from Life Support Education once payment is received.

 

 

 

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.