Academic Affairs Department Trauma Courses

REGISTRATION FORM
Please fill in the shaded areas as applicable to you

DATE: Day

/
Month

/
Year ATLS 1. PHTLS 2. ATCN ATOM

Course (please put an X)

Preferred Course Dates

First Name: 2nd Name Last Name: Specialty : (please select & circle) Intern Physician: Date of Graduation : Consultant, Resident, Other :

Nurse, Paramedic, EMT, Other : Department: Organization: P.O. Box: Country: Email: Telephone: (Work) (Mobile) (Fax)
Please submit Registration Form to: Trauma Courses Office Academic Affairs (mbc 1255) King Abdulaziz Medical City P. O. Box 22490, Riyadh 11426 K.S.A. Tel # +966-1-252-0088 Ext 13149 / 13496 / 11947 / 11921 Fax # +966-1-252-0630 Emails: ATLS@ngha.med.sa / PHTLS@ngha.med.sa / ATCN@ngha.med.sa / ATOM@ngha.med.sa

Mail Code:

City: Nationality:

Code:

(Home) (Pager) (Other Contact)

Please note that your registration will only be confirmed upon receipt of payment. Cancellation or re-booking requires a minimum of one-month notice. No refund will be given for cancellations/postponements made less than one month prior to the course date, or failure to attend the course.
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Office Use only

Receipt No.

Amount:

Date:

ATLS (Advanced Trauma Life Support) for Doctors

Sponsored by King Abdulaziz Medical City-NGHA in affiliation with the American College of Surgeons (ACS) - certificate is valid for 4 years

Provider Course Instructor Course

In-Kingdom SR 2,500 SR 1,290

Out of K.S.A. SR 2,700

Auditors * SR 125

Notes: - Course fee includes ATLS Manual (for Physicians only). - Refresher (recertification) half the fees. * Auditors (Nurses, Paramedics, EMTs) will receive certification of attendance.

PHTLS (Prehospital Trauma Life Support)

Sponsored by King Abdulaziz Medical City-NGHA in affiliation with the National Association of Emergency Medical Technicians (NAEMT) - certificate is valid for 4 years

Provider Course Nurses / Others NGHA Employees SR 480 Non-NGHA Employees SR 680 Instructor Course

EMTs/Paramedics SR 580 SR 680

Physicians SR 780 SR 880

NGHA Employees SR 400 Non-NGHA Employees SR 450

Notes: - Course fee includes PHTLS Manual with CD. - This course is designed mainly for Paramedics, EMTs, Physicians and Nurses

ATCN (Advanced Trauma Care for Nurses)

Sponsored by King Abdulaziz Medical City-NGHA in affiliation with the Society of Trauma Nurses (STN) certificate is valid for 4 years

Provider Course Instructor Course

NGHA Employees

SR 720 (SN2)

SR 900 (SN1)

Non-NGHA Employees SR 960 NGHA Employees SR 600 Non-NGHA Employees SR 700

Notes: - Course fee includes ATLS and ATCN Manuals - Copy of current valid nursing license should be submitted along with the Registration form.

ATOM (Advanced Trauma Operative Management) for Doctors

Sponsored by King Abdulaziz Medical City-NGHA in affiliation with the Hartford Hospital Trauma Center, Univ. of Connecticut School of Medicine

Provider Course

SR 3,200 (without course materials)

Notes: - Course fee do not include ATOM Manual with CD & ATOM Porcine Lab Component.
Course materials: Available at the Trauma Courses Office for SR1,352.00

Target Participants: 4th & 5th year Surgical Residents, Trauma Fellows, General Surgeons & others who wish to obtain a better knowledge of identifying and managing advanced operative trauma cases.

Cash payments or ATM Credit can be made at the Trauma Courses Office, Academic Affairs Department or by bank transfer to the following account: Name of Bank: Branch: Account Name: Account No.: Arab National Bank Riyadh Khashmallan Branch ESC/ATLS SA603040-01-08-00520891-008-4

To confirm Bank transfer payment, please send validated bank transmittal form by fax to +966-1-252-0630

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Note: The above fees do not include shipping charges of course materials.

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