BCLS Instructor Registration - Register in 3 easy steps

1. Select the date that you would like to attend and complete the form below. 2. Print this page, enclose payment to "NIEC" and any prerequisites listed on course description page.
3. Mail form, payment and
 prerequisites to:
     P.O. BOX 11176
     Philadelphia, PA 19136
FULL BCLS-I COURSE $350.00 (Please select one date)
Please select a date:

RECERTIFICATION BCLS-I COURSE $210.00 with textbook - $145.00 no textbook
Please select a date:



City: State:   Zip:

Phone (Day):   Evening:

Select one:  Physician  Nurse   Paramedic   EMT   Other:

**Cancellations if submitted at least 2 weeks prior to course will be accepted less $50.00 administrative fee.

+ Send copy of current BCLS card if registering for re-certification course.