NCBH/School of Medicine/WFBH Community Physicians Employee
BLS Refresher Registration Form

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


Date to Attend Time to Attend
April 3, 2014  
April 8, 2014       
April 30, 2014  
May 8, 2014  
May 16, 2014  
May 30, 2014  
June 4, 2014  
June 24, 2014  
June 30, 2014  
July 7, 2014  
July 18, 2014  
July 31, 2014  
August 7, 2014       
August 15, 2014  
August 29, 2014  
September 3, 2014  
September 11, 2014  
September 30, 2014  

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.
Last Name
First Name
Middle Initial
Employee ID
Credentials (MD, RN, etc)
Phone Number
Alternate Phone Number
Department Name
Department Number
E-mail Address
Re-Enter E-mail Address
We will notify you of your acceptance into the class through the e-mail address you provided.


Quick Reference

Life Support Education
Tiffany Loggins
For BLS, ACLS, & ITLS Questions

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

Contact Tiffany

Jill Pettit
For PALS, NRP, ENPC, TNCC, PITLS, & E-Learning Questions

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

Contact Jill

3rd Floor South Building
Find a Doctor Ways to Give
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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.