REGISTRATION FORM

(CAPITAL LETTERS)

Date:

Name of Work Shop: BLS / ACLS / PALS / Heartsaver FA/CPR/AED / ECG and Pharmacology / Basic Ultrasound
Applicant’s Name:
S/o, D/o, W/o: QUALIFICATION:
Date of Birth: cNIC No.
Designation: SPECIALTYT:
Institute: PMDC No:
Postal Address:
E-mail: @
CONTACT
Hospital: Clinic:
Residence: Mobile:

Previous Attend Workshop:

(Please Specify Date/Venue/Organizer/Course Title / attached previous expired AHA card)

Rules & Regulations of attending Workshop

o Punctuality and 100% attendance of all sessions of the course is mandatory to get AHA card. Late coming and omission of a
single module can result in disqualification, marked ABSENT, and required to pay an additional fee of Rs.2500, so to be adjusted
in the next available course. The fee once paid is non-refundable/non-transferable once the course date is announced.
o Please bring ORIGINAL Manual to class, without original manual candidates are not allowed to attend the class. Mobiles to be
kept on silent mode. Smoking, chewing gums strictly prohibited.
o Students who are unable to pass the exam and the skill tests during the course will be called for
REMEDIATION without any additional fee.
o Student who are unable to PASS the EXAM and SKILL TEST or fail to attend the remediation on a date announced by the Institute
of BoschMedicus will have to pay additional fee Rs.3500 for BLS Course and Rs.6000 for Advance Courses (ACLS / PALS) and
will be adjusted in the next available course that they will have to attend completely.
o Approximate BLS course length is 5 hours with 6 Participants, if number of participants increase add 15min each Participant.
Refreshment or lunch break time not included in actual course time

Instructor / TCC Approval

Signature of Applicant
For Official Use:

Receipt No: Receipt Date Course Date

Course Fee; BLS US$ 55 Heartcode BLS US$ 60 - ACLS US$ 95 PALS US$ 120
Page ½
American Heart Association Course Fees Disclaimer
The American Heart Association strongly promotes knowledge and proficiency in all AHA courses and has developed instructional materials for this purpose.
Use of these materials in an educational course does not represent course sponsorship by the AHA. Any fees charged for such a course, except for a portion of
fees needed for AHA course materials, do not represent income to the AHA.
 Terms & Conditions
1. The fee charged for the course is to cover the expenditure on the import of course
material and course cards. The logistics for the course are provided by the Institute
of BoschMedicus (Pvt.) Ltd.

2. Students who cannot attend the course on an announced course date, MUST inform
the Institute of BoschMedicus at least week before the course, otherwise they will be
marked as ABSENT and will have to pay additional fee of Rs. 2000, so to be adjusted
in the next available course.

3. Maximum allowed late arrival is as follow

a) BLS 10 Minutes from time of start of the course
b) ACLS Day1 10 Minutes from time of start of the course
c) ACLS Day2 05 Minutes from time of start of the course
d) PALS Day1 10 Minutes from time of start of the course
e) PALS Day2 05 Minutes from time of start of the course

4. Students reaching the course venue LATE on the day of the course, will not be allowed
to attend the course, marked ABSENT, and required to pay an additional fee of Rs.
2500, so to be adjusted in the next available course.

5. Students who are unable to pass the exam and the skill tests during the course will be
called for REMEDIATION without any additional fee.

6. Student who are unable to PASS the EXAM and SKILL TEST or fail to attend the remediation on a date
announced by the Institute of BoschMedicus will have to pay additional fee Rs.4000 for BLS Course
and Rs.8000 for Advance Courses (ACLS / PALS) and will be adjusted in the next available course that
they will have to attend completely.

7. The fee once paid is non-refundable/non-transferable once the course date is announced.

Page 2/2

American Heart Association Course Fees Disclaimer

The American Heart Association strongly promotes knowledge and proficiency in all AHA courses and has developed instructional materials for this purpose.
Use of these materials in an educational course does not represent course sponsorship by the AHA. Any fees charged for such a course, except for a portion of
fees needed for AHA course materials, do not represent income to the AHA.