American College of Surgeons
ADVANCED TRAUMA LIFE SUPPORT PROVIDER COURSE APPLICATION
Dear ATLS Applicant
You are invited to attend a 2-Day ATLS Student Course or Partial Day Recertification Course to be held at Erlanger Medical Center by Erlanger Trauma Services.
Please download and complete the ATLS application by answering each item and return completed form to address listed.
Application Requirements:
1. Address:
· Include the address where to mail ATLS materials. A non-refundable $100 deposit is required before materials will be mailed. (Further payment information below.)
2. Email:
· A valid email address is required in order to receive the ATLS Pre-Test link. The pre-test must be completed prior to the course date in order to pass the class.
· If you have trouble accessing the link, please contact Regena Young via the information listed below.
3. Payment:
· Course payment may be made by check, money order, or electronically. On-line credit card payments may be made through the Erlanger Trauma Services Provider Education webpage. There is a 3% processing fee incorporated into on-line payment through the Erlanger Shopify website. https://www.erlanger.org/medical-services/center-of-excellence-trauma-services/provider-education
American College of Surgeons
→ 2 Day ATLS Student Course - $800.
→ Half Day Refresher Course - $475
→ 2-Day ATLS Course Audit $250 or Free*
*Requires Coordinator Approval early arrival, assisting with set-up & breakdown of equipment
American College of Surgeons
· You may pay in full at the time you register for the course or, you may send a non-refundable deposit of $100 with your registration document and pay the remaining balance in full during registration on Day 1 of the ATLS course.
· ATLS course materials will not be mailed until Erlanger Trauma Services either receives the $100 deposit or the $800/$475/$250 course fee.
4. Scheduled Attendance, Cancellations & Refunds:
· The $100 ATLS registration & book deposit is non-refundable.
· If you are not able to attend the initial ATLS course you registered for, the deposit may be applied to the next scheduled ATLS course only with appropriate notification.
· Notification of withdrawal from a scheduled ATLS course must occur no later than 2 weeks prior to the date of the course in order to receive a refund of the remaining course fees.
· Attendee “No Shows” will forfeit any moneys paid toward ATLS course fees and will not be allowed to apply these monies toward a future course.
5. Over-Registration:
· If Erlanger Health System – Trauma Services receives more applicants for a course than the American College of Surgeons allows, two options are available:
A. Course fees will be refunded in full to the applicant.
B. Or, you may request that your deposit be retained by Erlanger Trauma Services to attend the next available ATLS course.
If you have any questions or concerns, please feel free to contact me. Thank you for your interest in Erlanger Health System – Trauma Services’ ATLS course.
Regena J. Young, RN, BSN - Outreach & Injury Prevention Erlanger Health System - Trauma Services
975 EAST THIRD STREET - Whitehall 520
(423) 778-5620 – Office (423) 847-5208 - Cell Chattanooga, TN 37403