Atls registration information

ATLS REGISTRATION INFORMATION
Name: ___________________________________
Title: MD____ DO ____ Other: _______
Resident: (circle one) Y N
Specialty: ________________________________
Employer:________________________________
Refresher Course: Expiration Date/ATLS #: ____________________/____________________
Street Address: (course materials will be mailed to this address)

City, State, Zip: ______________________________

Daytime Phone: ______________________________
Fax Number: ________________________________
Email address: _______________________________
CIRCLE THE COURSE YOU WISH TO ATTEND:

Provider Courses

February 8-9, 2013

November 8-9, 2013

Refresher Courses

February 9, 2013

April 20, 2013

November 9, 2013

For more information contact the Trauma office:

Office: [phone], Fax: [phone]

[e-mail]

Advanced

Trauma

Life

Support®

2013

Provider/Refresher

Course Schedule
Sponsored by:

Kansas Committee on Trauma

American College of Surgeons

in cooperation with

Trauma Services

University of Kansas Hospital

3901 Rainbow Blvd, MS 1011

Kansas City, KS 66160

Course Objectives

The ATLS course is designed to train physicians who are in a position to provide the first hours of emergency care to trauma victims.  The course utilizes didactic lectures and practical skill stations in order to effectively teach the principles of rapid, effective assessment and stabilization.  Successful candidates will be awarded four-year certification.  All courses are conducted according to the guidelines of the American College of Surgeons.

Educational Objectives
The participant, upon completion of the ATLS course, will be able to:

• 
  Demonstrate understanding of concepts and principles of patient assessment and management.
  
• 
  Perform skills necessary to diagnose and treat traumatic injuries.
  
• 
  Establish management priorities in single & multiple trauma.
  
• 
  Perform the initial assessment and management of trauma victims
  

Tuition/Registration fees:

• 
  Provider Course: $850.00
  
• 
  Refresher Course: $575.00
  
• 
  Special pricing
  
  • 
    Physician Extender: $675.00 (P)/$375.00 (R)
    
  • 
    Resident: $400 (P)/$250 (R)
    
  • 
    Auditor: $150.00 – Provider only
    

Fees include continental breakfasts, lunches, course material, lab fees, other related costs and amenities involved in making this a pleasant learning experience.
**MANDATORY FOR REFRESHER COURSE**:

A copy of your current ATLS® card must accompany your enrollment application. Without it, we cannot accept your application.


Course Location: Westwood Campus

2330 Shawnee Mission Parkway

Westwood, KS 66205


To enroll, complete the entire course enrollment form and mail, with a check payable to University of Kansas Hospital, to the address below. Course material cannot be sent until the registration fee and enrollment form has been received. Course materials will be sent out 30 days prior to the course, unless payment and the registration form are received after this date.

SORRY, WE DO NOT ACCEPT CREDIT CARDS NOR CAN WE ACCEPT REGISTRATIONS BY PHONE.

University of Kansas Hospital Trauma Services reserves the right to cancel the program due to insufficient enrollment. In this event, you will be notified and your entire registration fee refunded.

**REFUNDS AND CANCELLATIONS**:

Absolutely NO refunds will be issued if participants can not attend the class in which they are registered. However, we do allow substitutes in their place and allow them to register for a course offered on a different date.

Refunds will only be issued if we cancel the class.
CME Credit:

The American College of Surgeons is accredited by the Accreditation council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The American College of Surgeons designated this educational activity for a maximum (Provider-19, Refresher- 5) AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation to the activity.

RETURN WITH FEE TO:

University of Kansas Hospital

Trauma Services

3901 Rainbow Blvd

Mail Stop 1011

Kansas City, KS 66160

Checks must be made out to University of Kansas Hospital
In accordance with the Americans with Disabilities Act, please advise Trauma Services if you have any disability that requires special materials and/or services so that appropriate personnel can be advised.