AHLS Registration Fees

 

         

Course closes 2 weeks prior to the course date.

Early bird* Registration

Regular Registration

Provider & Instructor

$630

$650

Provider

$520

$540

Instructor

$230

$250

* Early bird registration applies to all registrations received 6  weeks prior to course

Complete and return form below by mail, fax or scan/email: 

 

Florida Poison Information Center - Jacksonville

655 West 8th Street, Box C-23

Jacksonville, FL 32209

Phone: (904) 244-4465

FAX: (904) 244-4063

nnichols@poison.ufl.edu

 

Title:

First :

Last:

Are you a (circle one): 

Paramedic        Nurse          Physician             Other
 

R.Ph.                  Pharm.D.    Industrial Hygienist

Address:

Checks Payable to: Florida Poison Information Center Jacksonville

City:                            State                Zip

VISA/MC CARD#                                                 Security Code:

Home#

Expiration Date       /   /         Amount

Work#

Cardholder's Name

Your Position:

Email Address:

Method of Payment:       Check         Credit card

Which program (circle):

 

Feb 3-4, (Provider), Feb 5 (Instructor), 2021 [Virtual Course]

                                                                                                  Hosted by Jacksonville, FL

May 5-6, (Provider), May 7 (Instructor), 2021 [Virtual Course]

                                                                                                  Hosted by Jacksonville, FL

Aug 4-5, (Provider), Aug 6 (Instructor), 2021 [Virtual Course]

                                                                                                  Hosted by Jacksonville, FL

Nov 3-4, (Provider), Nov 5 (Instructor), 2021 [Virtual Course]

                                                                                                  Hosted by Jacksonville, FL

Which program will you attend: (circle one)

Provider & Instructor         Provider           Instructor

 

All course materials will be FedEx'd to you prior to the program?

 

Must have computer, stable internet, webcam, microphone and speakers to attend course.

Refund Policy

Cancellation in writing:

45 to 8 days prior to program -  course fee minus 15%

7 to 3 days prior to program -  50% refund

48 hours prior to program -   No Refund