Participant/Applicant Name

Credentials

License Number

Unique Identifier (Month/day of birth and last 4 digits of ssn)

Hospital Affiliation

Mailing Address (include street, town, state and zip)

Email Address

Special Needs

BLS Certification / Located in SIM lab / Cost $35 BLS Certification / Located in SIM lab / Cost $353/11/2020 from 5:30 to 7:30 pm, $353/18/2020 from Noon to 1 pm, $354/16/2020 from 7 to 8 am, $354/29/2020 from 4 to 6 pm, $355/12/2020 from 3 to 5 pm, $356/10/2020 from 7 to 8 am, $356/18/2020 from 4 to 6 pm, $357/9/2020 from 4 to 6 pm, $357/15/2020 from 2 to 3 pm, $358/12/2020 from 5 to 7 pm, $359/18/2020 from 7 to 8 am, $359/30/2020 from 5:30 to 7:30 pm, $3510/15/2020 from 2 to 4 pm, $3510/23/2020 from 5 to 6 pm, $3511/11/2020 from 4 to 6 pm, $3511/17/2020 from Noon to 1 pm, $3511/25/2020 from 3 to 5 pm, $3512/10/2020 from 4 to 6 pm, $3512/16/2020 from Noon to 1 pm, $351/14/2021 from 5:30 to 6:30 pm, $351/21/2021 from 3 to 5 pm, $35

ACLS Certification (2 Days) / Located in C & Sim Lab / Cost $175 ACLS Certification (2 Days) / Located in C & Sim Lab / Cost $1758/10 and 8/11/2020 from 8 am to 4 pm, $175

ACLS Recertification / Located in the C & Sim Lab / Cost $100 ACLS Recertification / Located in the C & Sim Lab / Cost $1003/18/2020 from 8 am to Noon, $1003/18/2020 from 1 to 5 pm, $1004/16/2020 from 8am to Noon, $1006/10/2020 from 8 am to Noon, $1007/15/2020 from 3 to 7 pm, $1009/18/2020 from 8 am to Noon, $10010/23/2020 from 1 to 5 pm, $10011/17/2020 from 8 am to Noon, $10012/16/2020 from 1 to 5 pm, $1001/14/2021 from 1:30 to 5:30 pm, $100

PALS Certification (2 Days) / Located in C & Sim Lab / $100 PALS Certification (2 Days) / Located in C & Sim Lab / $1006/25 and 6/26/2020 from 8 am to 4 pm, $100

PALS Recertification / Located in C & Sim Lab / $100 PALS Recertification / Located in C & Sim Lab / $1008/20/2020 from 8 am to Noon, $10011/17/2020 from 1 to 5 pm, $10012/16/2020 from 8 am to Noon, $100