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Course
Registration Form
Please ensure payment is submitted with registration form. ONLINE
Registration and Payment is a TWO-STEP process: 1) Go to the Courses Offered page and add the course(s) to your cart and complete the secure online payment process via PayPal (no
PayPal account required). 2) Return to this page, complete then submit this registration form. Registration and Payment submitted via Mail: Please press
the white PRINTER FRIENDLY button (at the bottom of the form) THEN complete the form, print the form, and remit
with payment. Payments may be made using personal check, cashier's check, money order, or Company PO, and USD only. Class
Location: Karns Fire Department Station #1, 6616 Beaver Ridge RD, Karns, TN next to the Karns Lions
Community Park. Each class block is scheduled for 4.0 Contact Hours. These contact hours
may be converted to up to 0.4 CEU per class for First Responders, EMTs, and Paramedics. The all-inclusive fee for each
module is only $20.00 per person. Lead Instructors: Ronnie
D Patterson and John S Holloway. Please contact us
if you need housing information or travel directions. These
continuing education activities are approved by Benchmark Medical Services, LLC, an organization accredited by the Continuing
Education Coordinating Board for Emergency Medical Services (CECBEMS). CECBEMS is the national accrediting body established
to develop and implement policies to standardize the review and approval of EMS continuing education activities. For additional
information on CECBEMS, go to www.cecbems.org.
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No
refunds. Courses missed may be rescheduled. Benchmark is not responsible for items lost or damaged during shipping.
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AHA DISCLAIMER: The American
Heart Association (AHA) strongly promotes knowledge and proficiency in BLS, ACLS, and PALS and has developed instructional
materials for this purpose. Use of these materials in an educational course does not represent course sponsorship by the American
Heart Association. Any fees charged for such a course, except for a portion of fees needed for AHA course materials, do not
represent income to the Association.
COURSE COMPLETION: Course completion is defined as: The participant
successfully demonstrated the core knowledge on said date and Benchmark, its faculty, staff, assistants, and agents
neither implicitly nor explicitly guarantees any degree of future performance. Therefore, by participating
in this activity, the participant hereby indemnifies and holds harmless Benchmark, its faculty, staff, assistants, and
agents from any claims that may arise from participation in this activity or activities. The participant furthermore
agrees and understands that comprehension and performance is an individual responsibility; that Benchmark does not license
or certify individuals in skills or procedures; and that the participant must adhere to local standing orders, protocols,
or other medical direction, and within the individual's scope of practice. COURSE COMPLETION DOCUMENTATION REPLACEMENT
POLICY: Post Course documentation is mailed via U.S. Post Office to the address entered during
registration. Post course documentation is presumed to
have been received unless returned by the U.S. Post Office. If returned by the U.S. Post Office, the documents will be held
until you contact us. A replacement fee of $25.00 per document will be assessed for any reason other than an error on
our part. PRIVACY NOTICE: Submission of information
will be retained for course attendance, participation and reporting as may be required by the course sponsor and or distributor
of continuing medical education certificates. This information may be used to notify the participant of future licensure
/ certification or continuing education or training opportunities. Benchmark protects the registrant personal information
as protected under HIPPA, protecting against public inspection absent a subpoena or for the purposes of health oversight activities
as described herein. SUBMISSION: By submitting registration information
and participating in the registered course, you attest that you have read, understand, and agree with the course disclaimers,
terms, and conditions, and that you have submitted to the best of your knowledge correct and true information.
You also acknowledge that it is your responsibility to notify Benchmark in the event of any change in information within
thirty days of such change.
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