BLS Instructor Course Registration
Check [ ] Copy of BLS/CPR Healthcare Provider card
[ ] Core Instructor Course certificate
Course Location: Jersey City Medical Center EMS (415 Montgomery Street, Jersey City NJ)
Home Phone :_________________________Work Phone:_______________________
Course Fees LibertyHealth Employees: $150.00 (books, CDs and handbook)
Healthcare Provider: $250.00 (books, CDs and handbook are included)
Cancellations are subjected to a fee as follow:
Cancellations between 6-10 days prior to the course are subject to a 25% cancellation fee.
Cancellations between 2-5 days prior to the course are subject to a 50% cancellation fee.
No refunds for cancellation 2 business days and less.
IF MAILING/DROPPING OFF THIS FORM:
Amount Enclosed: $_____________________Cash, Check: #_________________
Make checks payable to: Jersey City Medical Center (JCMC CPR)
Mail To: Liberty Health - Jersey City Medical Center
355 Grand Street
Jersey City, NJ 07302
Attn: ACLS Training Center
IF EMAILING THIS FORM TO TRAINING@JCMCEMS.ORG, note that you MUST pay online using
the PayPal Buy Now button on the Course Applications page.
All registrations must be pre-paid. No seats will be reserved, or CME, CEUs awarded, without payment.
No refunds or credits will be issued for incomplete course work, failures or absences. Available seats are
filled first come first serve basis. Telephone registrations will not be accepted. We reserve the right to
cancel any course due to lack of enrollment.