Please fill in the shaded areas as applicable to you
DATE: / / / / / MALE / FEMALE
Day / Month / Year
Course (please put an X)
Preferred Course Dates / ATLS® / PHTLS® / ATCN® / ATOM®
1. / 2.
First Name: /
2nd Name /
Last Name: /
Specialty :
(please select & circle) / Intern / Date of Graduation :
Physician: / Consultant, Resident, Other :
Nurse, Paramedic, EMT, Other :
Organization/Company/Institution:
Department: / NGHA Mail Code:
P.O. Box: / City: / Code:
Country: / Nationality:
Email:
Saudi Commission for Health Specialties Number:
Telephone: / (Work) / (Home)
(Mobile) / (Pager)
(Fax) / (Other Contact)
Please submit Registration Form to:
Trauma Courses Office
Academic Affairs (mbc 1255)
King Abdulaziz Medical City
P. O. Box 22490, Riyadh 11426 K.S.A.
Tel # +966-1-80-48437 / 48456 / 48432 /
48436 / 48438 / 48434 / 48462
Fax # +966-1-252-0630
Emails: / / / / Please note that your registration will only be confirmed upon receipt of payment. Cancellation or re-booking requires a minimum of one-month notice.
No refund will be given for cancellations/postponements made less than one month prior to the course date, or failure to attend the course.
Office Use only
Receipt No. / Amount: / Date:
ATLS® (Advanced Trauma Life Support) for Doctors
Sponsored by King Abdulaziz Medical City-NGHA
in affiliation with the American College of Surgeons (ACS) - certificate is valid for 4 years
Provider Course / In-Kingdom / Out of K.S.A. / Auditors *
SR 2,500 / SR 2,700 / SR 125
Instructor Course / SR 1,290
Notes: - Course fee includes ATLS Manual (for Physicians only).
- Refresher (recertification) half the fees.
* Auditors (Nurses, Paramedics, EMT’s) will receive certification of attendance.
PHTLS (Prehospital Trauma Life Support)
Sponsored by King Abdulaziz Medical City-NGHA in affiliation with
the National Association of Emergency Medical Technicians (NAEMT) - certificate is valid for 4 years
Provider Course / Nurses / Others / EMT’s/Paramedics / Physicians
NGHA Employees / SR 480 / SR 580 / SR 780
Non-NGHA Employees / SR 680 / SR 680 / SR 880
Instructor Course / NGHA Employees / SR 400
Non-NGHA Employees / SR 450
Notes: - Course fee includes PHTLS Manual with CD.
- This course is designed mainly for Paramedics, EMT’s, Physicians and Nurses
ATCN (Advanced Trauma Care for Nurses)
Sponsored by King Abdulaziz Medical City-NGHA
in affiliation with the Society of Trauma Nurses (STN) – certificate is valid for 4 years
Provider Course / NGHA Employees / SR 720 (SN2) / SR 900 (SN1)
Non-NGHA Employees / SR 960
Instructor Course / NGHA Employees / SR 600
Non-NGHA Employees / SR 700
Notes: - Course fee includes ATLS and ATCN Manuals
- Copy of current valid nursing license should be submitted along with the Registration form.
ATOM® (Advanced Trauma Operative Management) for Doctors
Sponsored by King Abdulaziz Medical City-NGHA
in affiliation with the American College of Surgeons (ACS)
Provider Course / SR 3,200 (without course materials)
Notes: - Course fee do not include ATOM Manual with CD & ATOM Porcine Lab Component.
Course materials: Available at the Trauma Courses Office for SR1,352.00
Target Participants: 4th & 5th year Surgical Residents, Trauma Fellows, General Surgeons & others who
wish to obtain a better knowledge of identifying and managing advanced operative
trauma cases.
Cash payments or ATM Credit can be made at the Trauma Courses Office, Academic Affairs Department or by bank transfer to the following account:
Name of Bank: Arab National Bank – Riyadh
Branch: Khashmallan Branch
Account Name: ESC/ATLS
Account No.: SA603040-01-08-00520891-008-4
To confirm Bank transfer payment, please send validated bank transmittal form by fax to +966-1-252-0630
Note: The above fees do not include shipping charges of course materials.
Tc2012