Advanced Trauma Life Support

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Advanced Trauma Life Support
Rural Trauma Team Development Course
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ATLS Course Registration Form

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Course Date:

mm/dd/yy

Check Type:

Provider (Initial 2 day course)

Re-verification (Refresher 1/2 day course)

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Audit

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The spelling of your name, as identified here, is how it will appear on the certificate of course completion.

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Residency Program:

(Family Practice, Int. Med, Emer., Surgery, Ortho, etc.)

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Date Completed:

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Current Practice Specialty:

(Family Practice, Int. Med, Emer., Surgery, Ortho, etc.)

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Tulane University Advanced Trauma Life Support, 1430 Tulane Ave. SL-22, New Orleans, LA 70112 ttei@tulane.edu