ATLS - Advanced Trauma Life Support India Program

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17

October, 2024

Microsoft Word - ATLS Provider Form

King George's Medical University

Description

ADDRESS INFORMATION
Prof. Samir Misra ATLS Training Programme 2ndFloor,Centre for Advance Skills Development
Atal Bihari Vajpayee Scientific Convention Center King George’s Medical University, UP Lucknow - 226003

Email:- drsamirmisra@gmail.com,atls@kgmcindia.edu
Mobile:- 9839036117, 9453314651 .

COURSE FEE DETAILS:

Fees Information

Participants from India & SAARC Countries - Rs 21500
Doctors in Govt. Services & Armed forces - Rs. 16500
Resident Doctors - Rs. 11500
Other Foreign Nationals - USD 600

Submit proof along with the registration form.

PLEASE PROVIDE THE FOLLOWING CONTACT INFORMATION

Please give your option for ATLS Provider Course :

Option A

Option B

Name

Title

Age

Designation

Speciality

Year of Graduation

Post Graduate Qualification

Year of Post Graduation

Hospital

Full Address

Communication

Zip/Postal Code

Country

Work Phone

FAX

Mobile

Date of any ATLS Provider course attended along with the registration number

Date of any ATLS Instructor course attended along with the registration number

Are you interested in and available for the Instructor course? (Please note that you must successfully complete the Student Course and be identified as having instructor potential to attend the Instructor Course) Yes No

Submit

COURSES FOR TRAUMA, AND RESEARCH

TRAUMA IN RESEARCH AND TEACHING.

ATLS ^® Approved Sites

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