BLS Instructor Course - REGISTRATION FORM
Venue:
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: Maximum 20 participants per session. Registration is only confirmed upon receipt of FULL PAYMENT.

Email address *
Full Name (as per MyKad) *
(For printing on Certificate)
Your answer
MyKad No. *
Your answer
Contact No. (H/P) *
Your answer
Working Place / Hospital
Your answer
Course Date *
Required
PRE-REQUISITE: BLS Certificate is valid (not more than 2 years) *
Category *
Payment mode *
Registration Confirmation
Registration is only confirmed upon receipt of FULL PAYMENT. Secretariat will send you the enrollment form, please fill-in and return with VALID BLS CERTIFICATE at your soonest to reserve your seat. Payment instructions will follow.
**Payments made are strictly non-refundable
Registration Fee *
For enquiries, please contact:
Secretariat, National Heart Association of Malaysia
Website: www.malaysianheart.org
Email: secretariat@malaysianheart.org
Tel: 03-7931 7900
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