Advanced Trauma Life Support

Registration

When you have completed the form, we will be notified automatically. You should receive an email confirming the date of your course and providing details for payment of the relevant course fee.

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Course

1Basic info

Title First name Surname Calling name ID/Passport no. Passport number if not an SA citizen

2Your profile

Present position e.g. COSMO, Springbok, Gauteng, Hout Bay etc Nationality e.g. South African HPCSA Registration no. Qualification, year and place e.g. MBChB 2001 (Pretoria)60 characters left Summarised CV Summary of last 3 year experience200 characters left Why do you want to do the ATLS course Summary of why you would like to do this course200 characters left Diet requirements Special requirements or food allergies50 characters left

3Contact info

Email address

Cell phone no. Home phone no. Business phone no. Local PostNet store Click to find your nearest branch

Residential address
Address line 1 Address line 2 Address line 3 Postal code

Postal address

Same as residential address?

Address line 1 Address line 2 Address line 3 Postal code

Business Details
Current Hospital/Facility City

4Verify you're human

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