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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 page, add the course(s) to your cart then complete the secure online payment process. 2) After payment is processed, you will be redirected to the Registration Form.  Registration is NOT complete until we have received both the electronic registration and full payment in U.S. funds. Benchmark is not responsible for registrants failing to complete the registrations process as described herein. 

Registration and Payment submitted via Mail:   First,  press the white PRINTER FRIENDLY button (at the bottom of the form), THEN complete the form, print the form, and remit with payment. Payments must be made in U.S. Dollars by  cashier's check, money order, company/organization check, or company PO.  Registration is NOT complete until we have received both the registration form and full payment in U.S. funds. Benchmark is not responsible for registrants failing to complete the registration process as described herein. 

Course location:  Unless otherwise noted, courses are conducted at:  Delta Medical Center, 3000 Getwell Road, Memphis, TN. 
Maps and directions are available through Mapquest or similar services. Please contact us if you need a list of area hotels. 

Course descriptions, pricing, and payment information is located on the Course Descriptions, Pricing, and Payment page..

 

Check the box(es) next to the course(s) for which you are registering. 

 

 

ADD-ON COURSES: To  add  either  the  PALS  add-on  or  the  ITLS  add-on,  go  to  the  Courses  Offered  page  and  look  under  DOT  EMT/PARAMEDIC  COURSE  ADD-ONS,  click  the  appropriate  ADD  TO  CART  tab,  and  follow   directions  to  submit  payment.

 

The EMS Refreshers, EMR/1st Responder Refresher Hours Courses, ITLS, and ACLS activities are approved 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.The cosponsoring organizations of CECBEMS are the National Association of Emergency Medical Technicians, the American College of Emergency Physicians, the National Association of Emergency Medical Services Physicians, the National Association of State Emergency Medical Services Directors, the National Council of State Emergency Medical Services Training Coordinators, and the National Registry of Emergency Medical Technicians.  
For additional information on CECBEMS, go to www.cecbems.org.

Incomplete registration forms will not be processed. If you do not receive a non-automated email registration confirmation from us within 72 hours of registering for a course, your registration may not be complete. In this case, please contact us immediately at benchmarkems@bellsouth .net.
Non-automated registration and if applicable, payment confirmations are sent via email FROM BenchmarkEMS@bellsouth.net TO the email address as it is entered on the registration form.

American Heart Association Online Courses
HeartCode ACLS Update (renewal) Part 1 - Online
HeartCode ACLS Update (renewal) Part 2 - Skills - Contact for Appointment
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HeartCode Bloodborne Pathogens - Online
American Heart Association Basic Life Support for Healthcare Rroviders (CPR)

CPR classes are offered on a course request basis and as a part of the EMS Refresher Courses. Please contact us to schedule your CPR class.

American Heart Association ACLS Courses
ACLS Provider JAN 9, 2015 8:30am
ACLS Provider MAR 6, 2015 8:30am
ACLS Renewal MAR 13, 2015 5:00 pm
ACLS Renewal MAY 1, 2015 5:00pm
ACLS Provider JULY 17, 2015 8:30am
ACLS Renewal JULY 17, 2015 5:00pm
ACLS Renewal AUG 8, 2015 5:00pm
ACLS Provider SEPT 4, 2015 5:00 pm
ACLS Provider NOV 13, 2015 8:30am
ACLS Renewal NOV 13, 2015 5:00 pm
American Heart Association PALS Courses
PALS Provider JAN 10, 2015 8:30am
PALS Add-On FEB 28, 2015 1pm
   Add-On Pre-requisite:  Completion of the JAN 2015 AEMT or FEB 2015 Paramedic Refresher Course.
PALS Provider MAY 2, 2015 8:30am
PALS Provider JULY 18, 2015 8:30am
PALS Provider SEPT 5, 2015 8:30am
PALS Provider NOV 14, 2015 8:30am
PALS Add-On NOV 22, 2014 1:00 pm
    Add-On Pre-requisite:  Completion of the OCT 2014 AEMT or NOV 2014 Paramedic Refresher Course.

New EMS Education and Scope of Practice EMT and Paramedic Refresher Courses

The following courses are conducted at Delta Medical Center in Memphis, TN. Detailed course descriptions and costs are on the Course Descritions, Pricing, and Payment page.

 

EMT/AEMT Refresher Course includes the EMT-IV to AEMT Transition JAN 30 & 31, 2015, 8am - 8pm

 

Paramedic Refresher Course, February 20, 21, 27, & 28, 2015, 8am - 8pm

This class INCLUDES the transition required to maintain national registry and transition to the new National Registry Paramedic (NRP).

1st Responder/Emergency Medical Responder (EMR)  Initial Course

DOT TN 1st Responder Initial

TBD

First Responder Refresher Course

TBD

 

 

 

ITLS Provider Renewal / Add-On Course
Add-On Pre-requisite: Completion of the OCT 2014 AEMT or NOV 2014 Paramedic Refresher Course.

March 14, 2015 8:00 am
November 23, 2014 8:00 am

ITLS Provider Completer Course (Initial)

    Completer Pre-requisites:  Options:  1) Completion of the JAN 2015 AEMT or FEB 2015 Refresher Course; OR 2) or complete the ITLS eTrauma online portion.  Proof of online completion is required by the registration deadline.  Go to http://www.itrauma.org/ and follow the registration information for the eOnline Provider Course.
February 14, 2015 8:00 am
November 23, 2014 8:00 am

Pediatric ITLS Provider / Add-On Course

PROVIDER: March 21, 2015 8:00 am
ADD-ON: March 21, 2015 8:00 am
Add-On Pre-requisite:  Completion of the JAN 2015 AEMT or FEB 2015 Paramedic Refresher Course.

NAME as it appears on your certification or license

 * required
   

Best Phone Number Contact
(xxx) xxx-xxxx

 * required

Email address
Email is our primary means of communication. Please provide a valid email address you will check frequently and take the proper steps to allow email communications from Benchmarkems@bellsouth.net.  Benchmark is not responsible for information not received. Edit Text

 * required

Home Mailing Address

 * required

City,  State,  and  Zip Code

 * required

Gender   (M or F)

 * required

Date of Birth   (MM / DD / YYYY)

 * required

Employer
If registering for a First Responder initial or refresher course, please list the squad/company with whom you are affiliated and not your employer.

 * required
   

Level of Certification or Licensure
(MD, PA, RN, APN, EMT-B, EMT-IV, EMT-P, First Responder, etc)

 * required

State of Licensure     
(2 letter abbrev.)

 * required

State Certification / License Number
Please omit the 0's in front of the numbers.
Enter your Certification or License Number and not your renewal number.
Enter "n/a" if not applicable.

 * required

State Certification / License Expiration Date    (MM/DD/YYYY)
Enter "n/a" if not applicable.

 * required

National Registry Number
Enter "n/a" if not applicable.

 * required

National Registry Expiration     (MM/DD/YYYY)
Enter "n/a" if not applicable.

 * required

Method of Payment
Selecting online payment will NOT automatically redirect you to the PaPal page.  After completing this form and pressing the SUBMIT button, please go to the Courses Offered page and follow the instructions on that page.

Online Credit/Debit Card via PayPal
Cashier's Check or Money Order
Company Purchase Order
Pay 1/2 now. Invoice will be emailed.

Before clicking SUBMIT please read the disclaimers, terms, conditions, agreements, and notices below. 

Please update via Email on future Benchmark courses and events.
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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 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. 

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 MATERIALS:  Course materials when applicable are usually mailed within 3 - 5 business days of registration completion. Online course codes and instructions are usually emailed within 1 - 2 business days of registration completion.  Benchmark does not accept liability or responsibility for shipments/emails not received, lost, or damaged.

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 continuing education or training opportunities. Benchmark makes reasonable attempts to protect participant personal information submitted against public inspection and disclosure absent a subpoena or for the purposes of health oversight activities as described herein.

REFUNDS/CANCELLATIONS:   No refunds are allowed for online access purchases. No refunds will be issued after the course registration has closed.  Courses may be re-scheduled for a $100.00 Course Change Fee, must be paid by Cashier's Check or Money Order, and received by Benchmark before the change request will be confirmed. Course change requests are granted based upon availability. Re-scheduled courses must be completed with Benchmark within ninety (90) days of the original scheduled date or the registration fee, and if applicable, change fee(s) will be forfeited. The Course Change Fee is applicable to any course change request. Benchmark is not responsible if a course is not available or if no seat is available within the ninety day requirement.The registration fee minus a $50.00 cancellation fee may be refunded if a cancellation request is received before the course is closed, before the registration deadline date, or if course materials have not been mailed. If course materials have been mailed, the course registration has closed, or the registration deadline has passed, no refund will be issued. There are no refunds for online course purchases. Benchmark reserves the right to implement policy on a case by case basis for circumstances not addressed herein. 

SUBMISSION:  By submitting registration information and participating in the registered course, the registrant/participant, hereafter referred to as "you" or "your", attest that you have read, understand, and agree with the course disclaimers, terms, submission agreement, conditions, and notices, and that you have submitted to the best of your knowledge correct and true information. Benchmark does not guarantee whether implicitly or explicitly comprehension or future performance. You understand that learning, comprehension, and functioning at your level of licensure or certification and adhering to the Standard of Care, Scope/Duty of Care, and Scope of Practice is an individual responsibility; thereby, you agree to hold harmless Benchmark, its agents, employees, and instructors from any and all personal and professional liability and expense including attorney's fees and costs arising from, or as a result of, your negligence. You acknowledge that it is your responsibility to notify Benchmark immediately via email of any change in information used for the purpose of registration to help ensure proper and timely notification and or receipt of course information or documentation.