BASIC LIFE SUPPORT

COURSE

REGISTRATION

Name_________________________

Social Sec. Num.________________

Address________________________

_______________________________

_______________________________

Telephone______________________

Affiliation_______________________

Course Date____________________

I have read and understand the refund and cancellation policies in this brochure.

Signature: __________________________

Make checks payable to:

Underwood Memorial Hospital

Return form to:

EMS ACADEMY

Underwood-Memorial Hosp. MICU

238 South Evergreen Avenue

Woodbury, NJ 08096

Registration will not be accepted

without fees.

Instructor Course Dates

2001

April 20, 21, 22 2001

June 15, 16, 17 2001

September 28, 29, 30 2001

Visit our Web Site

www.umh-micu.org

For more information about our training programs or to schedule classes at your site contact us at:

UMH-MICU

238 S Evergreen Ave

Woodbury, NJ 08096

856 384 1000


COURSE OFFERINGS

Friends/Family Course

is designed for the layperson that has an interest in learning adult cardiopulmony resuscitaiton and choking skills . The course also contains very basic cardiac and pulmonary anatomy and physiology as well as tips for heart disease prevention and heart attack recognition.

Pediatric Friends/Family

is for those who have an interest in learning child and infant cardiopulmonary resuscitaion and choking skills as well as childproofing the home.

BLS HEALTHCARE PROV.

was developed for the healthcare professional. This course includes adult one and two-rescuer cardiopulmonary resuscitation, choking skills, cardiopulmonary anatomy and physiology, use of barrier devices and the perdiatric components. This course is open to anyone but is recommended for those persons required to hold a course completion card for BLS for the Healthcare Provider.

BLS INSTRUCTOR COURSE

is designed to give students the information needed to become an Instructor of Basic Life Support. Prerequisites include a current BLS for the Healthcare Provider course completion card and a letter of interest.

COURSE FEES*

Friends / Family CPR

$30.00 per student

9am, 2nd Saturday of every month

Pediatric Friends / Family

$30.00 per student

1pm, 2nd Saturday of every month

Friends / Family & Pediatric

$50.00 per student

9am-5pm, 2nd Saturday of the month

BLS HEALTHCARE PROV.

$50.00 per student

9am, 3rd Saturday (Basic)

7:00pm, 4th Monday (Renewal)

BLS INSTRUCTOR

$150.00 per student

Dates listed on Back

Course dates subject to change to accomodate holidays.

REFUND POLICY

Refunds will be made less a 10% processing fee upon written notice of cancellation at least five working days prior to the course date. All fees are forfieted if notice is not given. All fees will be refunded if we are forced to cancel the course. Refunds may take up to thirty days to be processed.

COURSE LOCATION

Nursing Education Building

Underwood-Memorial Hospital

Broad and Redbank Aves

Woodbury, NJ

For additional information contact us at:

856 384 1000

*Underwood-Memorial Hosp. is an accredited BLS training center of the American Heart Association, New Jersey Affiliate. As such, we are authorized to charge tuition fees for courses. These fees do not represent income to the American Heart Association or any of its components.