AHLS Registration Fees

 

                                                

 

 

Registration Form (.pdf format)

Course closes 6 weeks prior to the course date.

Early bird* Registration Regular Registration
Provider & Instructor $515 $540
Provider $405 $430
Instructor $175 $195
* Early bird registration applies to all registrations received 8  weeks prior to course

                                                                 .

 

Complete and return form below by mail or fax: 

 

Florida Poison Information Center - Jacksonville

655 West 8th Street, Box C-23

Jacksonville, FL 32209

FAX: (904) 244-4063

 

Title:

First :

Last:

Are you a (circle one): 

Paramedic        Nurse          Physician             Other
 

R.Ph.                 Pharm.D.      Industrial Hygienist
 
Address: Checks Payable to: Florida Poison Information Center Jacksonville
City:                            State                Zip VISA/MC CARD#
Home# Expiration Date       /   /     Amount
Work# Cardholder's Name
Your Position:

Email Address:

 Method of Payment:  Check    Credit card      PO

Which program (circle):

Jan 30-31 (Provider), Feb 1 (Instructor), 2008                      [Jacksonville, FL]

March 26-27 (Provider), March 28 (Instructor), 2008          [Jacksonville, FL]

July 30-31 (Provider), Aug 1 (Instructor), 2008                     [Jacksonville, FL]

Nov 5-6 (Provider), Nov 7 (Instructor), 2008                         [Jacksonville, FL]

Which Program will you attend: (circle one)
 

Provider & Instructor         Provider           Instructor

Refund Policy

Cancellation in writing:

45 to 8 days prior to program  course fee minus 15%

7 to 3 days prior to program    50% refund

48 hours prior to program        No Refund