2075 Bayview Avenue, Toronto, Ontario, M4N 3M5, ACLS Phone: (416) 480-4943
Advanced Cardiac Life Support® Registration Form (ACLS)
Name:
Course Date Requested:
Professional Title (Fam. Phys., RN, Paramedic, Resident Mailing Address (Please include Postal Code):
etc):
Home Phone (including Area Code): Work Phone (including Area Code): Email Address: University Affiliation (if applicable): • • • •
Hospital (if applicable):
This is a definite booking for the above course. Your booking will be confirmed with the receipt of your payment, which is due a minimum of one month prior to the course The Course Manual will be mailed via First Class Mail as soon as Registration Form and Payment have been received at this office. Please return this Registration Form by email, fax or regular mail. Your cheque, in Canadian funds, should be sent to: ACLS Office, Room H~265 Sunnybrook Health Sciences Centre 2075 Bayview Avenue Toronto, ON M4N 3M5, Canada
Please make cheque payable to: Sunnybrook Hospital
If you have further questions please contact Terry Smith at the ACLS office by Phone: 416 480-4943, Fax: 416 480-5325 or Email: terryg.smith@sunnybrook.ca .
CANCELLATION POLICY
If you cancel your booking 2 weeks or less in advance of the course date, a penalty will be charged of half the course cost, or retainment of the deposit amount. If you cancel your booking 1 week or less in advance of the course date, no refund will be given. Course dates are subject to change or cancellation. All Cancellations on your part are subject to a $20.00 Administration Fee
Sunnybrook Health Sciences Centre
Fully affiliated with the University of Toronto