AHLS Registration Fees
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Course closes 3 weeks prior to
the course date. |
Early bird* Registration |
Regular Registration |
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Provider & Instructor |
$630 |
$650 |
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Provider |
$520 |
$540 |
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Instructor |
$230 |
$250 |
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*
Early bird registration applies to
all registrations received 6
weeks prior to course |
||
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Complete and return form below by mail or 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
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Title: First: Last: |
Are you a (circle one): Paramedic Nurse Physician Other R.Ph. Pharm.D. Industrial
Hygienist |
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Address: |
Checks Payable to:
Florida Poison
Information Center Jacksonville |
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City: State Zip |
VISA/MC CARD# Security code: |
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Home# |
Expiration Date Amount |
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Work# |
Cardholder's Name |
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Your Position: Email Address: |
Method of Payment: Check Credit card |
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Which program (circle): |
Which program will you attend:
(circle one) |
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February 2-3, (Provider), February
4 (Instructor), 2022 [Virtual Course]
Hosted by Jacksonville, FL |
Provider & Instructor Provider Instructor |
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All course materials
will be sent to you prior |
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May 11-12, (Provider), May
13 (Instructor), 2022 [Virtual
Course]
Hosted by Jacksonville, FL |
to the program?
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Must have computer, stable internet, webcam, microphone and |
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August 3-4, (Provider), August
5 (Instructor), 2022 [Virtual Course]
Hosted by Jacksonville, FL |
speakers to attend course. |
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November 2-3, (Provider),
November 4 (Instructor), 2022 [Virtual Course]
Hosted by Jacksonville, FL |
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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