Registration

Registration Form

Course Name

Yes

I confirm that I am in possession of a valid, non-expired AHA Card (BLS/ACLS/PALS) OR have just registered for a BLS course.

Please email a copy of your CARD to sonja@cctraining.co.za before attending your course.

ACLS

Yes

I confirm that I am in possession of a valid, non-expired AHA Card (ACLS/ACLS EP).

Please email a copy of your CARD to sonja@cctraining.co.za before attending your course.

ACLS EP

Yes

I confirm that I am in possession of a valid, non-expired AHA Card (BLS/ACLS/PALS) OR have just registered for a BLS course.

Please email a copy of your CARD to sonja@cctraining.co.za before attending your course.

PALS

Yes

I confirm that I am in possession of a valid, non-expired AHA Card (PALS/PALS EP).

Please email a copy of your CARD to sonja@cctraining.co.za before attending your course.

PALS EP

BLSforHCP

ITLS

Yes

I confirm that I am in possession of a valid, non-expired AHA Card (BLS) OR have just registered for a BLS course.

Please email a copy of your CARD to sonja@cctraining.co.za before attending your course.

BLS Instructors

ECG

AHCP

First Aid

Pears

CPR Professionals

CPR Fam & Friend

Personal Information

Title

First Name

Surname

Date of Birth

ID Number

HPCSA NO

Dietery requests

Select(if required)

Specify (if other)

Your contact details

Textbook Address

Physical Address

Physical address we need to send your study material to (if applicable) during office hours (Postal fees are R100)

Postal Code

Telephone Number

Cellphone Number

Fax Number

Email Address

Cancellation / postponement clause

If you wish to cancel or postpone your course less than 6 weeks prior to the course date no refund will be given. Postponement fee is R2000 for advanced courses and R600 for BLS. Full refund minus the fees of the books (if you received manuals) will be given if cancellation or postponement is done more than 6 weeks prior to the course date. By sending this form you declare that the information furnished by you in the online application form is, to the best of your knowledge true and correct. You also acknowledge our company policy with regards to cancellations/ postponements.

I accept the cancellation /postponement clause

IMPORTANT NOTICE FOR: BLS and CPR Instructors course

In order to register for BLS or CPR Instructors course you have to possess a valid, non-expired AHA (BLS) card. See sample below

IMPORTANT NOTICE FOR: ACLS EP course

In order to register for ACLS EP course you have to possess a valid, non-expired AHA (ACLS) card. See sample below

IMPORTANT NOTICE FOR: PALS EP course

In order to register for PALS EP course you have to possess a valid, non-expired AHA (PALS) card. See sample below

REGISTRATION

IMPORTANT NOTICE FOR: BLS and CPR Instructors course

IMPORTANT NOTICE FOR: ACLS EP course

IMPORTANT NOTICE FOR: PALS EP course

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