BLS COURSE - REGISTRATION FORM
BASIC LIFE SUPPORT (BLS) COURSE - FOR PROVIDER (HEALTH PROFESSIONALS & PUBLIC)
National Heart Association of Malaysia, D-13A-06, Menara Suezcap 1, KL Gateway
No.2 Jalan Kerinchi, Gerbang Kerinchi Lestari, 59200 Kuala Lumpur
Tel: +603-7931 7900 Email: secretariat@malaysianheart.org

IMPORTANT NOTE: Class will only proceed if we meet the MINIMUM of 8 participants. Should we fall short, the class will be postponed to the next available date. ALL PAYMENTS MADE ARE NON-REFUNDABLE.
Email address *
Full Name (as per MyKad / Passport) *
(For printing on Certificate)
Your answer
MyKad No. / Passport No. *
(FOR PASSPORT - please indicate country)
Your answer
Contact No. (H/P) *
Your answer
Working Place / Hospital
Your answer
Course Date *
Note: Minimum 8 participants, maximum 20 participants. By opting the date you have agreed to the "IMPORTANT NOTE" as indicated above. Date is subject to changes - for latest update please check our website www.malaysianheart.org
Required
Previously attended BLS Course *
How did you hear about us
Category *
Payment mode *
(Payment must be made prior to course. We DO NOT accept cash on-site. Payments are STRICTLY non-refundable)
Registration Fee *
(inclusive of 6% SST)
EARLY-BIRD REGISTRATION FEE
Applicable to payment ONE-MONTH prior to course date. Cut-off date/time of payment will be advised via email by secretariat. Please check website (http://bit.ly/NHAM_BLS) for more information.
For enquiries, please contact:
Secretariat, National Heart Association of Malaysia
Website: www.malaysianheart.org
Email: secretariat@malaysianheart.org
Tel: 03-7931 7900
A copy of your responses will be emailed to the address you provided.
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