ACLS EP Course - Registration by Mail

VITAL DATA  - Mail this completed registration to Coleman Education @ 2812 E. Harrington Road;  Simi Valley, CA 93065 regardless of choice of payment (mail OR credit card – see below). 

Name: (print) ________________________________________________________________________________

Title:  M.D._____ D.O._____ R.N._____ EMT-P_____ Other___________________________________________

Address: (print) ________________________________City:___________________State:____Zip:___________

Day Phone:    (___)______________________________  Evening Phone:  _(    _)_________________________       

Cell Phone:  _(      )______________________________ Pager:_(      )__________________________________

 Fax:  _(      )___________________________________ Email Address:_________________________________

Course Date:__________________________ Course Location:________________________________________

Textbooks for this course:  The mandatory ACLS-EP Provider Manual is actually two great books ordered as a set.  There are 2 options for you to order your AHA required ACLS-EP Textbooks:

1.  Call "World Point" @ 888-322-8350 (ext. 128- Jennifer Kish) and request Product #:  70-2500. 

2.   Add $50.00 to the $175.00 Training Fee.

Textbooks must be purchased prior to attending the weekend class, and The AHA requires all course participants to bring a current copy of the textbooks to the class. 

We highly encourage you to review the AHA Course Textbooks prior to the class to maximize your learning experience.

The AHA Course Books will be made available for purchase ($50./set) - CASH ONLY at the class.

 TWO COURSE PAYMENT OPTIONS:    Training Fee is $175.00

 1.  Make Check or Money Order for Course Dates - Payable to Coleman Education.      Mail to :

     Coleman Education Opportunities, Inc., 2812 Harrington Rd., Simi Valley, CA   93065

2.  To register via Credit Card, return to the main Registration Page and  click on the "button" below  the dates for the ACLS-EP course.

Payments via credit card will be assessed an additional $5.00 fee.

Coleman Education Opportunities, Inc. appreciates your business