OU MEDICAL CENTER
Education & Organizational Development
Registration Application Form
Fill in the form below and fax to (405) 271-5153 or email to tennille.taylor@hcahealthcare.com.
Completing the Registration Application Form does not guarantee enrollment. Courses are
filled on a first come first serve basis based on seating availability. A confirmation notice will be
sent to all inquirees along with payment instructions and other class details.
Name:
Address:
City:
State:
Zip:
Home Phone:
Work Phone:
Alternate Phone/Pager:
Fax Number:
Email Address:
Put an “X” in the box next to the course that you wish to attend. Type/write in the Preferred Date.
Course
ACLS – New Provider
ACLS EP
ACLS Recertification – HeartCode Program
Basic Arrhythmia Interpretation Course
BLS Healthcare Provider Course – New Provider
BLS Healthcare Provider Course – Recertification
BLS Healthcare Provider Instructor Course – New
BLS Healthcare Provider Instructor Course – Recertification
Clinical Day
Diabetes Workshop: Understanding Diabetes
Emergency Nurses Pediatric Course
Intravenous Therapy Course
Medical Surgical Certification Review Course
ONS Chemotherapy & Biotherapy Course
Pediatric Symposium
Trauma Nurse Certification Course
Other:
Other:
Preferred Date(s)