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ACLS Recertification Registration Form
ACLS Recertification Form
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* Indicates required question
Date of Desired Course: Saturday, September 26th, 2020
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MM
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DD
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YYYY
Last ACLS Course Taken:
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Your answer
Heart and Stroke Foundation (HSF) Certification #
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Your answer
Full Name
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Your answer
City
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Your answer
Mailing Address (*cannot ship to PO Box)
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Your answer
Postal Code
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Your answer
Contact Number
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Your answer
Email Address (the one you have used in the past for Heart and Stroke Foundation)
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Your answer
Occupation
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Physician
Registered Nurse
Medical Resident
Paramedic
Respiratory Therapist
Other:
Hospital Where You Work
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Your answer
Department Worked
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Your answer
Payment Information and Options
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Recertification Course $425.00
Choose
E-Transfer to jordan.oliver@northernhealth.ca
Cheque made payable to "ACLS PG"
Manager to Pay - Manager must send email approval to jordan.oliver@northernhealth.ca
ACLS Pre-Requisites (Must Have)
Heart & Stroke Foundation CPR 'C'
Good understanding of ECG Rhythm Analysis
Any Dietary Restrictions
None
Gluten Free
Vegetarian
Vegan
Lactose Into
Other:
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