Mobile Life Support Services Inc.

Fall 2012 CME Opportunities

Please complete the Registration Form below by indicating which course you are requesting and Fax to David Grass, Education Coordinator, 845-562-4055

Advanced Cardiac Life Support (Provider)

Dates: Time: Mondays 10/29 & 11/5/2012 0900-1600 MLSS Headquarters 3188 Rte 9W New Windsor, NY 12553 10/22/2012

Advanced Medical Life Support (Provider)

Dates: Time: Mondays 10/8 & 10/15/2012 0900-1600 MLSS Headquarters 3188 Rte 9W New Windsor, NY 12553 10/1/2012

Registration Deadline:

Registration Deadline:

Advanced Medical Life Support (Provider)

Time: Location: Saturdays 11/10 & 11/17/2012 0900-1600 Orange Regional Medical Center Conference Center 707 East Main Street Middletown, NY 10940 11/5/2012

Pediatric Advanced Life Support (Provider)

Time: Location: Saturdays 12/8 & 12/15/2012 0900-1600 Orange Regional Medical Center Conference Center 707 East Main Street Middletown, NY 10940 12/3/2012

Registration Deadline: Dates: Time:

Registration Deadline: Dates: Time:

Pediatric Advanced Life Support (Provider)

Mondays 11/12 & 11/19/2012 0900-1600 MLSS Headquarters 3188 Rte 9W New Windsor, NY 12553 11/5/2012

PreHospital Trauma Life Support (Provider)

Mondays 9/17 & 9/24/2012 0900-1600 MLSS Headquarters 3188 Rte 9W New Windsor, NY 12553 9/10/2012

Registration Deadline: Time: Location:

Registration Deadline: Time: Location:

Advanced Cardiac Life Support (Provider)

Saturdays 10/6 & 10/13/2012 0900-1600 Orange Regional Medical Center Conference Center 707 East Main Street Middletown, NY 10940 10/2/2012

PreHospital Trauma Life Support (Provider)

Saturdays 9/22 & 9/29/2012 0900-1600 Orange Regional Medical Center Conference Center 707 East Main Street Middletown, NY 10940 9/17/2012

Registration Deadline:

Registration Deadline:

Name

Home #:

Address

Day/Cell #:

EMAIL: Affiliation

FAX TO: David Grass, Education Coordiantor @ 845-562-4055

SEE PAGE 2 FOR COURSE REQUIREMENTS, TEXTBOOK INFORMATION AND PRICING

Tuition for ACLS,PALS,AMLS or PHTLS: MLSS Employee: $0.00 ORMC Staff: $200.00 All Others: $250.00 per course plus textbooks All students are responsible for aquiring Textbooks. COURSE PRE-TESTS for ACLS & PALS must be completed and presented on the first sesion MLSS Staff may contact the Education Coordinator to borrow textbooks a deposit will be collected and returned upon return of text.

Textbooks can be ordered as follows: www.EmergencyStuff.com or call ACLS Provider Text: Tel.: 800-611-6083 PALS Provider Text: Tel.: 800-611-6083 PHTLS Provider Text: Tel.: 800-367-0382 AMLS Provider Text: Tel.: 800-367-0382