Emergency Neurologic Life Support Certification Course Friday, February 27, 2015 OR Saturday February 28, 2015 15 Hours CME / CEU Credits First Time in Upstate New York ! Registration Space is Limited ! This Course Offering is Endorsed by the Neurocritical Care Society Registration Deadline: February 20, 2015 REGISTRATION FORM ( please print clearly – we will need to contact you ) FEES: Ideal Course for any professional caring for patients with potential acute neurologic injury CME and CEU accreditation: University of California at San Francisco. The American Nurses Credentialing Center accepts AMA PRA Category 1 Credit™ issued by organizations accredited by the ACCME Faculty report no conflicts of interest Attending Physician: PA, NP, Pharmacist RN, Resident: $ 350 $ 200 $ 150 Circle Choice of Date: Friday, Feb. 27, 2015 OR Saturday Feb. 28, 2015 Full Name: ________________________________________________ Address: _________________________________________________ Telephone: __ _______________________________________________ Email: __________________________________________________ Course Schedule: 07:30 – 08:00 Registration and Breakfast 08:00 – 16:30 (approx.) Classes, Breaks, Lunch 16:30 (approx.) Adjourn REGISTRATION INCLUDES: Access to online Course Materials and Exam, ENLS Certificate (requires passing grade), Registration in NCS ENLS Provider Database, CME Certificate, Continental Breakfast, Lunches, Break Refreshments (we cannot accommodate special meal requests). Course Faculty (NCS‐Certified Instructors) James E. Szalados, MD, MBA, Esq, FCCP, FCCM Director Surgical Critical Care, and Neurocritical Care Rochester General Hospital, Rochester Regional Health System Chad Miller, MD, FNCS Neurocritical Care, Vascular Neurology, and In‐patient Neurology Marion General Hospital, OhioHealth, System Medical Chief, Neuroscience Regional Development and Clinical Integration REGISTRATION DEADLINE: February 20, 2015 (no exceptions) MAIL CHECKS / MONEY ORDER PAYABLE TO: SZALADOS / ENLS Course 325 Woodmill Drive, Rochester, NY., 14626‐1176 Contact: (585) 704‐0418 Email: [email protected] REGISTRATION AND PAYMENT INSTRUCTIONS: • Registration is limited based on capacity • Include payment with your completed registration form. • We cannot accept corporate group checks (personal checks only) • Do not send cash • Registration not complete without payment & email confirmation • You will receive a receipt by email at the time of your registration