Pediatric Advanced Life Support for Provider Course (Non - HA ...

Pediatric Advanced Life Support for Provider Course
(Non - HA Paediatricans Only)
Name : Mr. / Ms. / Dr. / Drs. __ ( )
In Chinese
Non-HA Staff / HA Staff - Occupation & Rank:___________________________________
Hospital / Dept: _______________________________________
Corresponding Address: _______________________________________________________
E-mail address: _________________________________________
Telephone: Mobile - ________________________________ Residence/Pager - _____________________________
Course Date:
Class I : 2, 3 Oct 2013
Class J : 4, 5 Oct 2013
Class K : 17, 24 Nov 2013
Class L : 8, 15 Dec 2013
Time: 08:30 – 17:30
(Wed, Thu)
(Fri, Sat)
(Sun)
(Sun)
Course fee:
$2,200.00 – textbook @
$2,000.00 – textbook included (HA Staff) #@
# Please attach a copy of HA staff card for reference
@ Please attach a copy of valid AHA BLS provider certificate or equivalent cert (e.g In-hospital training)
Collect course manual: Self-collect HK$40 (Courier Service)
Delivery Address: as above corresponding address
Others:_________________________________________________________
Notes :
- No Refund will be made except course is oversubscribed or cancelled; Number of seat
remaining can be check at http://www.ha.org.hk/aetc/enrollment
- $100 handling fee is required if course date is requested to be changed by student after
payment has been confirmed;
- Participant will be notified to collect the course materials by email at least 8 weeks before
course date
- If no email is received 2 weeks after the submission, please contact us . Tel: 3553 3300
Signature: Date :
Payment method: 1) Cheque payable to “ Hospital Authority” together with application form send to the
following address at least 14 working days in advance
Mailing Address: Finance Department, 4/F Ruttonjee Hospital,
266 Queen’s Road East, Wanchai, Hong Kong
2) Payment by cash or EPS will be accepted at Shroff, G/F Ruttonjee Hospital
Shroff opening hours
Mon – Fri : 8:50am – 1pm, 1:30pm – 5pm
Sat : 8:50am – 1pm (closed on Sunday & Public Holiday)