Medicine.llu.edu
[pic]
AHA COURSE REGISTRATION/PAYMENT VERIFICATION FORM
FAX TO: (909) 558-0967 or EMAIL TO: simulationcenter@llu.edu
Name of Employee/Student Employee/Student#
Date E-mail address
BLS
( ONLINE COURSE + SKILLS TESTING = $55
ACLS
( ONLINE COURSE + SKILLS TESTING = $175
PALS
( ONLINE COURSE + SKILLS TESTING = $175
*Please note, in order to take ACLS or PALS you need a current BLS card. If you don’t have one, register for BLS also*
[pic]
*Signature above authorizes Loma Linda University Medical Simulation Center to charge via Journal Voucher the above-noted department and/or unit for
BLS, ACLS, and PALS certification provided for above-said employee/student.
*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*
The Medical Simulation Center also accepts Visa or MC. If you are paying by credit card, please fill in the information below:
- - - (Visa (MC / $
Credit Card Number Exp. Date Amount
Signature of Card Holder
*Please note, all sales are final
................
................
In order to avoid copyright disputes, this page is only a partial summary.
To fulfill the demand for quickly locating and searching documents.
It is intelligent file search solution for home and business.