AHA BLS Course

AHA BLS - External Student Registration Form

Dear Candidate,

Thank you for choosing to enroll for training with the Life Support Training (LiST) Department, SCOPE.

To register for course training please fill out the form below:

Note:

Shifa LiST Center registration process works on FIFO Method (First in First Out).

"Once the fee is submitted, there will be no refunds"

" This form is for External (non Shifa) participants only "

Candidate Name

Certificates will be issued under the spelling provided here

Category of Medical Professional

Doctor

Nurse

Others

For Post Graduates & Students:

Please mention your current year of medical education E.g. PG I, PG II, PG III, PG IV or Year of Graduation

ID Card Number

Please provide your CNIC number

Mailing Address

Please provide your mailing address

Cell phone

Email Address

Any Previous training

Payment Information:

AHA BLS Course Fee is PKR 20,000/- (Twenty thousand only)

All payments must be deposited at:

Title of Account: Shifa Foundation

Bank: Allied Bank Limited

Branch: I–8 Markaz, Islamabad (Branch Code 0947)

Account No.(From other banks): 0947–0010008262400015

Account No.(From Allied bank): 0010008262400015

IBAN: PK72 ABPA 0010008262400015

Swift Code: ABPA PKKA AHA

Note: Please note that the fee is not refundable once submitted. If the participant is late or absent without informing the ITC they will be charged with the Penalty fee (For more details on this please contact 051-8464721)

AHA Disclaimer:

" The American Heart Association strongly promotes knowledge and proficiency in all AHA courses and has developed instructional materials for this purpose. Use of these materials in an educational course does not represent course sponsorship by the AHA. Any fees charged for such a course, except for a portion of fees needed for AHA course materials, do not represent income to the AHA."

Mode of Payment?

Deposit Slip

On-line Transfer

Attestation:

Signature:

I attest that the information given above is correct to the best of my knowledge and allow Life Support Training (LiST) department, SCOPE to use the above mentioned information to contact me.

Ticking the checkbox below is to be considered the equivalent of my signature and consent for the above.

Signature:

Send me a copy of my responses

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