ࡱ> HJG[ 6bjbj 42ΐΐ @@,\"o^>>>"""""""$.'">">>>"O">8">": ,!U`| o""0" R'fV'!'!\>>>>>>>"">>>">>>>'>>>>>>>>>@ I: FAmerican Heart Association International Training Centre Baba Farid University of Health Sciences, Faridkot Heart Saver/BLS/ACLS/PALS Provider Courses Registration Form (to be filled in CAPITAL letters)  Registration Form (To be filled in CAPITAL letters) Course : BLS/ACLS/Both BLS & ACLS/PALS (Tick as applicable) Date of Course : _______________________ Participant Name(in capitals): Father Name : Mother Name : Department: Permanent Address State : PIN:Correspondence Address State : PIN: QualificationMobile No.Alternate Phone :EmailRegistration Fee (Non refundable) BLS Heart code (One Day) Rs. 3000/- (includes BLS heartcode , AHA Course Completion Card, Certificate, Tea / Coffee) BLS and ACLS Course (2 days) Rs. 6000/- (includes BLS Heartcode online, ACLS E-book, 2 AHA Course completion cards, Certificate, Tea/Coffee) PALS Course (2 days) Rs. 5000/- (Includes PALS Book, AHA Course completion card, Certificate, Tea/Coffee)PAYMENT DETAILSCash / Bank Transfer No. Amount Bank Details Date For direct payment in bank : Oriental Bank of Commerce Branch : BFUHS, FARIDKOT ACCOUNT NO : 160 120 11000 505 A/C NAME : BFUHS A/C AHA-ITC IFSC CODE : PUNB0160110 Registration Form & Payment Transfer Details may be sent through post or email ( HYPERLINK "mailto:bfuhs.itc@gmail.com" bfuhs.itc@gmail.com) to Dr. Ravinder Garg, Prof. & Head, Deptt of Medicine, GGS Medical College & Hospital, Faridkot 151203 (Punjab) Mobile No. 9988863800 Cash may be deposited with Mr. Sandeep Kumar (94640 09550), Pharmacy Officer, Department of Medicine, GGS Med. College & Hospital, Faridkot Registration is on first come first serve basis and the seats in each batch are limited. Please take ACLS pretest online on the website  HYPERLINK "http://www.heart.org/eccstudent" www.heart.org/eccstudent and bring the printed copy of same alongwith. (Only for ACLS candidates) Also register itself on website  HYPERLINK "http://www.cprverify.org" www.cprverify.org before coming for the course. Contact Us : website :  HYPERLINK "http://www.bfuhs.ac.in/AHAITC" www.bfuhs.ac.in/AHAITC email :  HYPERLINK "mailto:bfuhs.itc@gmail.com" bfuhs.itc@gmail.com For office Use Only BFUHS Receipt No . Dated .. 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