REGISTRATION FOR LONG BEACH MEMORIAL MEDICAL CENTER COURSES Please complete the information requested below and return with check or money order to: Long Beach Memorial Medical Center Nursing Education Department P.O. Box 1428 Long Beach, CA 90801-1428 (562)933-0640 Please make checks payable to LBMMC Nursing Education unless indicated otherwise.
Name: Address:
City:	Zip Code:
Phone:     Day (         )	Evening (         )
Title:     RN                                     LVN                                     Other
Professional License No.:
LBMMC / MCH / Saddleback Memorial / Orange Coast Memorial / Anaheim Memorial Employee
Non-employee
Please enroll me in the following classes as indicated with a check mark:

(   ) HeartCode Pediatric Advanced Life Support Renewal *MHS Employees Only* February 9, 2012 10:30 am - 12:30 pm Registration starts at 10:15 am. Employees: $40 Outreach Hospitals: 0 Non-Employees: 0 A current PALS provider manual can be purchased for an additional $39 if you do not already have a copy. (   ) HeartCode Pediatric Advanced Life Support Certification *MHS Employees Only* February 9, 2012 10:30 am - 12:30 pm Registration starts at 10:15 am. Employees: $80 Outreach Hospitals: 0 Non-Employees: 0 A current PALS Provider manual can be purchased for an additional $39 if you do not already have a copy. (   ) Dysrhythmia Interpretation & Therapeutic Modalities February 14, 17, 21, & 28, 2012 Day 1-3: 8:00 am to 4:00 pm Day 4: 8:00 am to 11:00 am Registration starts at 7:45 am. Employees: $105 Outreach Hospitals: $235 Non-Employees: $235 Pre-requisite requirement for MemorialCare NON-Licensed attendees. Successful completion of the online cardiac rhythm tutorial, Lippincott`s `Essentials of Cardiac Rhythm Recognition`. Without copy of certificate of completion, registration will not be accepted. (   ) Mgmt of Diabetes & Hyperglycemia in Hospitalized Patients:Part 2 *MHS Nurse Employees Only* February 20, 2012 8:00 am to 1:00 pm Registration starts at 7:45 am. There is no fee for this program. (   ) HeartCode Pediatric Advanced Life Support Certification *MHS Employees Only* March 8, 2012: 8:00 am to 10:00 am Registration starts at 7:45 am. Employees: $80 Outreach Hospitals: 0 Non-Employees: 0 A current PALS provider manual can be purchased for an additional $39 if you do not already have a copy. (   ) HeartCode Pediatric Advanced Life Support Renewal *MHS Employees Only* March 8, 2012: 8:00 am to 10:00 am Registration starts at 7:45 am. Employees: $40 Outreach Hospitals: 0 Non-Employees: 0 A current PALS provider manual can be purchased for an additional $39 if you do not already have a copy. (   ) Management of Diabetes & Hyperglycemia in Hospitalized Patients:Part I *MHS Nursing Employees Only* March 19, 2012 8:00 am to 1:00 pm Registration starts at 7:45 am. There is no fee for this program. (   ) HeartCode Pediatric Advanced Life Support Certification *MHS Employees Only* April 12, 2012 8:00 am - 10:00 am Registration starts at 7:45 am. Employees: $80 Outreach Hospitals: 0 Non-Employees: 0 A current PALS provider manual can be purchased for an additional $39 if you do not already have a copy. (   ) HeartCode Pediatric Advanced Life Support Renewal *MHS Employees Only* April 12, 2012 8:00 am - 10:00 am Registration starts at 7:45 am. Employees: $40 Outreach Hospitals: 0 Non-Employees: 0 A current PALS provider manual can be purchased for an additional $39 if you do not already have a copy. (   ) HeartCode Advanced Cardiac Life Support Renewal *MHS Employees Only* April 13, 2012 1:30 pm to 3:30 pm Registration starts at 1:00 pm. Employees: $40 Outreach Hospitals: 0 Non-Employees: 0 A current ACLS provider manual may be purchased for $34 if you do not already have a copy. Must submit a copy of current ACLS card with registration form. (   ) Advanced Cardiac Life Support Renewal *MHS Employees Only* April 13, 2012 8:00 am to 12:45 pm Registration starts at 7:30 am. Employees: $40 Outreach Hospitals: 0 Non-Employees: 0 A current ACLS provider manual may be purchased for $34 if you do not already have a copy. Must submit a copy of current ACLS card with registration. (   ) Mgmt of Diabetes & Hyperglycemia in Hospitalized Patients:Part 2 *MHS Nurse Employees Only* April 16, 2012 8:00 am to 1:00 pm Registration starts at 7:45 am. There is no fee for this program. (   ) Preceptor Course *LBM/MCHLB Nursing Employees Only* April 23, 2012 8:00 am to 3:30 pm Registration starts at 7:45 am. There is no fee for this program. (   ) Management of Diabetes & Hyperglycemia in Hospitalized Patients:Part I *MHS Nursing Employees Only* May 21, 2012 8:00 am to 1:00 pm Registration starts at 7:45 am. There is no fee for this program. (   ) Mgmt of Diabetes & Hyperglycemia in Hospitalized Patients:Part 2 *MHS Nurse Employees Only* June 18, 2012 8:00 am to 1:00 pm Registration starts at 7:45 am. There is no fee for this program.

AMERICAN HEART ASSOCIATION FEE DISCLAIMER The American Heart Association strongly promotes knowledge and proficiency in BLS, ACLS and PALS, and has developed instructional materials for this purpose. Use of these materials in an educational course does not represent course sponsorship by the American Heart Association, and any fees charged for such a course do not represent income to the Association.