TNCC Renewal Registration Form Outside Student

Please Note:
We cannot send out any class materials until we have received payment for the course.
 
Date to Attend  
Last Name
First Name     
Middle Initial     
Credentials (MD,RN,etc)
Address
City
State     
Zip Code
Phone Number
Employer
E-Mail Address
Method of Payment
   
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 by 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 Mikell White at 336-716-2800
 or stop by Life Support Education.
  
 
   
Comments or Concerns  
   
We will notify you of your acceptance into class through the email address you provided in this registration form.  

 

 


 

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

 

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.

© Wake Forest Baptist Medical Center, Medical Center Boulevard, Winston-Salem, NC 27157. All Rights Reserved.