Academic Affairs Department
Trauma Courses
REGISTRATION FORM
Please fill in the shaded areas as applicable to you
/
DATE:
Day
/
Month
ATLS®
Course (please put an X)
Preferred Course Dates
Year
PHTLS®
1.
ATCN®
ATOM®
2.
First Name:
2nd Name
Last Name:
Date of Graduation :
Intern
Specialty :
(please select & circle)
Physician:
Consultant, Resident, Other :
Nurse, Paramedic, EMT, Other :
Department:
Mail Code:
Organization:
P.O. Box:
City:
Country:
Code:
Nationality:
Email:
Telephone:
(Work)
(Home)
(Mobile)
(Pager)
(Fax)
(Other Contact)
Please submit Registration Form to:
Trauma Courses Office
Academic Affairs (mbc 1255)
King Abdulaziz Medical City
P. O. Box 22490, Riyadh 11426 K.S.A.
Tel # +966-1-252-0088
Ext 13149 / 13496 / 11947 / 11921
Fax # +966-1-252-0630
Emails: ATLS@ngha.med.sa /
PHTLS@ngha.med.sa / ATCN@ngha.med.sa /
ATOM@ngha.med.sa
Office Use only
Receipt No.
Amount:
Please note that your registration will only
be confirmed upon receipt of payment.
Cancellation or re-booking requires a
minimum of one-month notice.
No refund will be given for
cancellations/postponements made less
than one month prior to the course date,
or failure to attend the course.
Date:
atom/apr-07
ATLS® (Advanced Trauma Life Support) for Doctors
Sponsored by King Abdulaziz Medical City-NGHA
in affiliation with the American College of Surgeons (ACS) - certificate is valid for 4 years
In-Kingdom
SR 2,500
Provider Course
Instructor Course
Out of K.S.A.
SR 2,700
Auditors *
SR 125
SR 1,290
Notes: - Course fee includes ATLS Manual (for Physicians only).
- Refresher (recertification) half the fees.
* Auditors (Nurses, Paramedics, EMT’s) will receive certification of attendance.
PHTLS (Prehospital Trauma Life Support)
Sponsored by King Abdulaziz Medical City-NGHA in affiliation with
the National Association of Emergency Medical Technicians (NAEMT) - certificate is valid for 4 years
Provider Course
Nurses / Others
NGHA Employees
SR 480
Non-NGHA Employees SR 680
Instructor Course
EMT’s/Paramedics
SR 580
SR 680
Physicians
SR 780
SR 880
NGHA Employees
SR 400
Non-NGHA Employees SR 450
Notes: - Course fee includes PHTLS Manual with CD.
- This course is designed mainly for Paramedics, EMT’s, Physicians and Nurses
ATCN (Advanced Trauma Care for Nurses)
Sponsored by King Abdulaziz Medical City-NGHA
in affiliation with the Society of Trauma Nurses (STN) – certificate is valid for 4 years
Provider Course
NGHA Employees
SR 720 (SN2)
SR 900 (SN1)
Non-NGHA Employees SR 960
Instructor Course
NGHA Employees
SR 600
Non-NGHA Employees SR 700
Notes: - Course fee includes ATLS and ATCN Manuals
- Copy of current valid nursing license should be submitted along with the Registration form.
ATOM® (Advanced Trauma Operative Management) for Doctors
Sponsored by King Abdulaziz Medical City-NGHA
in affiliation with the Hartford Hospital Trauma Center, Univ. of Connecticut School of Medicine
Provider Course
SR 3,200 (without course materials)
Notes: - Course fee do not include ATOM Manual with CD & ATOM Porcine Lab Component.
Course materials: Available at the Trauma Courses Office for SR1,352.00
Target Participants: 4th & 5th year Surgical Residents, Trauma Fellows, General Surgeons & others who
wish to obtain a better knowledge of identifying and managing advanced operative
trauma cases.
Cash payments or ATM Credit can be made at the Trauma Courses Office, Academic Affairs
Department or by bank transfer to the following account:
Name of Bank:
Branch:
Account Name:
Account No.:
Arab National Bank – Riyadh
Khashmallan Branch
ESC/ATLS
SA603040-01-08-00520891-008-4
To confirm Bank transfer payment, please send validated bank transmittal form by fax to +966-1-252-0630
Note: The above fees do not include shipping charges of course materials.
atom/apr-07