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 materials 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

2024 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:

MonthDayYear
Date
Name

First NameLast 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 CodePhone Number
Profession or Job Title
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
COURSE DATE(S) Select only one: 2024 Dates*

March 6, 2024June 26, 2024September 4, 2024
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. Payments are non-refundable.
For late registration, please coordinator.
FAX NUMBER (205)638-6066

EMAIL: -Nursing.Education@childrensal.org
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