to Download Registration Form - Fortis Healthcare
to Download Registration Form - Fortis Healthcare
to Download Registration Form - Fortis Healthcare
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AHA COURSES REGISTRATION FORM<br />
[Please fill the details in CAPITAL letters]<br />
Name<br />
…………………………………………………………………………………..<br />
Organization<br />
…………………………………………………………………………………..<br />
Designation<br />
………………………………………………………………………………….<br />
Mailing Address<br />
…………..……………………………………………………………………….<br />
…………………………………………………………………………………..<br />
E-mail<br />
…………………………………………………………………………………..<br />
Sex ………………………………………………………………………………….<br />
Telephone with STD Code :-……………………………………………….<br />
Course Registered for (Please tick all the modules you are<br />
interested in)**<br />
Course<br />
Basic Life support Provider course<br />
(BLS)<br />
Advanced Cardiac Life support<br />
Provider course (ACLS)<br />
Pediatric advanced life Support<br />
Course (PALS)<br />
Heart saver First aid<br />
Applied<br />
For<br />
Specify the course date<br />
for as per the calendar
BLS Instruc<strong>to</strong>r<br />
ACLS Instruc<strong>to</strong>r<br />
PALS Instruc<strong>to</strong>r Instruc<strong>to</strong>r<br />
PAYMENT DETAILS:-<br />
By Cash/Cheque/DD No………….Dated…………drawn<br />
on…………………………<br />
(DD needs <strong>to</strong> be made in favor of International Hospital l imited<br />
payable at Noida.)<br />
For more information : -<br />
For more information, contact –<br />
ITC Co coordina<strong>to</strong>r:-<br />
Dr Dina shah<br />
PH:+918826372421<br />
email:shahdeena@yahoo.com
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