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:
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.
Full Name (as per MyKad / Passport)
(For printing on Certificate)
MyKad No. / Passport No.
(FOR PASSPORT - please indicate country)
Contact No. (H/P)
Working Place / Hospital
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
20 October 2019, Sunday
24 November 2019, Sunday
Previously attended BLS Course
How did you hear about us
Internet / Website / Facebook
Newspaper / Magazine
Allied Health Practitioner (Nurse, Paramedics etc. / WITH MEDICAL BACKGROUND)
Public (NO MEDICAL BACKGROUND)
Medical Graduate (> 18 years old)
Student (for age ≤ 18 years old only)
(Payment must be made prior to course. We DO NOT accept cash on-site. Payments are STRICTLY non-refundable)
Cheque (cheque deposit must be made prior to course)
Online Banking (via JomPAY channel)
(inclusive of 6% SST)
RM 180.00 per person (NHAM MEMBER - medical professionals who are NHAM members only)
RM 330.00 per person (NON MEMBER, > 18 years old)
RM 280.00 per person (STUDENT of age ≤ 18 years old only)
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 (
) for more information.
For enquiries, please contact:
Secretariat, National Heart Association of Malaysia
Tel: 03-7931 7900
A copy of your responses will be emailed to the address you provided.
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