BASIC LIFE SUPPORT INSTRUCTOR COURSE

The American Heart Association (AHA) strongly promotes knowledge and proficiency in BLS, ACLS and PALS Courses and has developed instructional mateirla for this purpose. Use of these materials in an educational course does not represent sponsorship by the Americn Heart Association. Any fees charged for such a course, except for a portion of fees needed for AHA Course materials, does not represent income to the Association.
BASIC LIFE SUPPORT INSTRUCTOR COURSE

2021 Registration
Submission of form required one week prior to class.
The Surpora Thomas Pediatric Nursing Education and Research Center

Nursing Professional Development Department - Children's of Alabama
Today's Date:

Month Day Year
Date
Name

First Name Last Name
Email: *
(If employee: firstname.lastname@childrensal.org
COA Employee ID#
NON COA-Employee list last 4 of SSN
Fee of $185.00 - by check payable to Nursing Education before access is given
Work Phone *

Area Code Phone Number
Profession or Job Title
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
COURSE DATE(S) Select only one: 2021 Dates *

March 17th June 16th September 15th December 8th
BLS Instructor Course participant must submit the following by mail or fax:

Registration Form

A completed "Instructor Candidate Application" (can be found at https://www.childrensal.org/workfiles/ClinicalServices/NursingEd/ahainstructorcandidateapplication

A copy of current BLS provider card

NOTE: If non COA - payment must be received before access is made available to online modules.
For late registration, please coordinator.
FAX NUMBER (205)638-6066

EMAIL: -Nursing.Education@childrensal.org
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