RESUSCITATION COUNCIL (UK) & ALSG

APPROVED AND CERTIFICATED COURSES

MR HARRY STEVENS
HEAD OF RESUSCITATION
Cwm Taf University Health Board
PRINCE CHARLES HOSPITAL
MERTHYR TYDFIL
CF47 9DT
TEL 01685 728204 (24 hour answer phone)
EMAIL: Louise.evans3@wales.nhs.uk

ALS Cost 485.00

8-9 Mar 14
5-6 Apr 14
10-11 May 14
19-20 Jul 14
18-19 Oct 14
29-30 Nov 14
31 Jan 15 1 Feb 15
7-8 Mar 15

EPLS Cost 485.00

22-23 Mar 14
28-29 Jun 14
30-31 Aug 14
1-2 Nov 14
10-11 Jan 15
21-22 Mar 15

FEEL COST 200

17 Oct 14

IMPACT COST 200

16-17 Feb 15

Tick Date
Required NLS Cost 250.00
FULL
10 Mar 14
26 July 14
27 July 14
25 Oct 14
6 Dec 14
7 Dec 14
14 Feb 15
15 Feb 15

FULL

ATLS COST 600

10-12 April 14
15-17 May 14
5-7 June 14
4-6 Sept 14
2-4 Oct 14
6-8 Nov 14
15-17 Jan 15
26-28 Feb 15

APLS COST 600

26-27 April 2014
5-6 July 2014
20-21 Sept 2014
21-22 Feb 2015
GIC COST 550
TBC

Tick Date
Required
FULL

FULL

FULL

APPLICATION FORM
ALS/ATLS/NLS/EPLS/APLS/ALERT/GIC/IMPACT/FEEL
SURNAME Hoebertz__________________________________________________
FORENAME _Nicole__________________________________________________________
TITLE __Miss________________________________________________________________
ADDRESS 98 Kilmorie Road, London_____________________________________________
____________________________________________________________________________
____________________________________________________________________________
_________________________________________POSTCODE_____SE23 2SR_____
TEL NO ____________________________________________________________________
EMAIL__nicihoebertz@hotmail.com___________DOB______21st of July 1973____________
PRESENT POST ___Locum_______ GRADE___SHO_________Yr__________________________
NAME OF TRUST __Great Ormond Street_________________________________________
HOSPITAL__Great Ormond Street_____DEPARTMENT_______Bank___________________
GMC/NMC/HPC PIN NUMBERS_________________________________________________
(PLEASE ENSURE THIS IS INCLUDED, RESUSCITATION COUNCIL REGULATIONS)
SIGNED _______________________________ DATE _______________________________
These courses include comprehensive course manual. The course fee does not
include accommodation or evening meals. No available refunds, alternative course
place will be offered at mutual convenience.
Cheques should be made payable to : Cwm Taf University Health Board.
and sent with your application form to:
Mr Harry Stevens
Resuscitation & Clinical Skills Department
Prince Charles Hospital
Merthyr Tydfil
CF47 9DT Tel 01685 728204
Email us at: Louise.evans3@wales.nhs.uk
CANCELLATIONS
MORE THAN 3 MONTHS-------- FULL REFUND
6-12 WEEKS--------------------- 75.00 Administration Fee
UNDER 6 WEEKS---------------- NO REFUND AVAILABLE
Course Required: ( EPLS
)
(eg: ALS/EPLS/NLS/ATLS/APLS/IMPACT/FEEL)
OFFICE USE ONLY
Cheque/memo/inv __________________
Confirmed by email __________________
Booked by____________ date__________
PACK SENT BY__________DATE_________
Receipt given _______________________

Date 1 st Choice:
Date 2 nd Choice:

Comments___________________
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