LIFE SUPPORT TRAINING COURSE REGISTRATION FORM Provider Course: Course Date:

Heart Saver

(Write in capital letters) First Name Last Name Nationality: Job Title: Institution / Department Specialty Organization

BLS

Mr.

ACLS

PALS

Ms.

National ID Number: Staff No. if MOH Employee:

Not Applicable Not Applicable

Contact Information (**Required) Mobile No. ** E-mail Address** Important Notice (Please Read) Book Policy: I am aware that all participants must have the manual during the course and that the usage of a photocopied manual is not allowed and against copyright laws. I am aware that the TC reserves the right to deny admission to participants who do not have the original manual. Cancellation or Non-Attendance Policy: (TC reserves the right to make necessary decisions on the validity of non-attendance reasons.) As per rules and regulations, the TC will not accept any refund (refer to refund policy) request if:  I have failed to notify my inability to attend for at least 2 weeks prior to the course date.  I have failed to attend the scheduled course without a valid reason/justification.  I am 15 minutes late from the first lesson without a valid reason/justification will be considered as non-attendance. Refund Policy: No refunds will be issued once the participant has received a part or the full course package. However, the participant can reschedule the course if the reporting of non-attendance has been made 2 weeks prior to the course. The participants will be allowed to re-schedule for the course with the same payment slip. The payment slip is valid for 6 months only from the reporting of non-attendance date. I have fully understood and will adhere with the above mentioned policies.

Applicants Signature: __________________________ Date: _________________________

Mode of Payment: Bank Transaction (15 OMR / Course) Account Name Royal Hospital Bank Name Bank Muscat Branch ROYAL HOSPITAL Account Number 0326000693620066 American Heart Association Disclaimer: “The American Heart Association strongly promotes knowledge and proficiency in CPR 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 course do not represent income to the association.”

+968 2459 9688

+968 2459 9967

[email protected]