Registration Form

Registration Form

BLS, ACLS and PALS Certification Classes
Name *

First Name Last Name
Email *
example@BMC.org
I am: *

BMC Faculty, Staff or Employee (Physician, NP, PA, Technician, Pharmacist, etc...) Member of the BMC Nursing Department (RN, LPN, CNA, etc...) Current BMC Resident or Fellow Employee of a BMC affiliated Community Health Center Faculty, Staff, Student or Employee of BU School of Dental Medicine BMC Travel or Dialysis Nurse, BUSM Student or Graduating BMC Resident Medical Professional from another facility

BMC Faculty and Staff

Physician, Psychologists, PA, NP, RT, Technician, MA, PT, etc...
BMC ID Number *
Position at BMC: *
i.e. MD, DO, CRNA, Resp Therapist, etc...
BMC Department *
i.e. Emergency Medicine, GIM, Cath Lab, Neuro, etc...
Please Register me for: *

Basic Life Support Only (BLS) Advanced Cardiovascular Life Support- Initial Certification Advanced Cardiovascular Life Support - Recertification Pediatric Advanced Life Support- Initial Certification Pediatric Advanced Life Support- Recertification
Optional: Add BLS Certification to ACLS or PALS classes *

No Yes

Members of the BMC Nursing Department

RN, LPN, CNA, etc...
BMC ID Number? *
i.e. 10012345
Position at BMC? *
i.e. RN, C.N.A., L.P.N, ....
BMC Department? *
i.e. M4W, MICU, ED, PICU, etc...
Please Register me for: *

Advanced Cardiovascular Life Support- Initial Certification Advanced Cardiovascular Life Support - Recertification Pediatric Advanced Life Support- Initial Certification Pediatric Advanced Life Support- Recertification
If you would like to add BLS certification to your ACLS or PALS class-

1- Check your Workday Learning "Required" section to see if Nursing Education has already assigned HeartCode BLS (It is automaticly assigned about 60 days prior to your expiration)

2- If you have not been assigned HeartCode BLS in Workday- Contact Lisa Falanga in Nursing Education to request it.

BMC Residents and Fellows
BMC ID Number? *
i.e. 10012345
Position at BMC? *
i.e. PGY-1 Resident, PGY-3 Resident, Fellow, etc...
BMC Department? *
i.e. Rheumatology, Emergency Medicine, BCRP Pedi, etc...
Please Register me for: *

Advanced Cardiovascular Life Support- Initial Certification Advanced Cardiovascular Life Support - Recertification Pediatric Advanced Life Support- Initial Certification Pediatric Advanced Life Support- Recertification
Optional: Add BLS Certification to Resident ACLS or PALS classes *

No Yes

Employee of BMC Affiliated Community Health Center
BMC ID Number?
i.e. 10012345 or U123454566
Level of Certification? *
i.e. MD, RN, Technician, etc...
Name of Community Health Center? *
i.e. Codman Square, East Boston, South Boston, etc...

BUSM Student, BUSM Graduate or Graduating BMC Resident or Fellow
BMC or BU ID number? *
What is your current status? *

BUSM Student/Graduate Graduating BMC Resident/Fellow BMC Travel or Dialysis Nurse

My Classes *

Basic Life Support Certification (BLS) HeartCode BLS with in-person skills session. (Can be taken alone or added to ACLS or PALS)

$ 75.00

Advanced Cardiovascular Life Support Certification (ACLS) HeartCode ACLS with in-person skills session

$ 275.00

Pediatric Advanced Life Support Certification (PALS) HeartCode PALS certification with in-person skills session

$ 275.00

Total

$ 0.00

BMC Faculty and Staff