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Course Registration Form

Please ensure payment is submitted with registration form.

ONLINE Registration and Payment is a TWO-STEP process:  1) Go to the Courses page, add the course(s) to your cart then complete the secure online payment process. 2) After payment is processed, you will be redirected to the Registration Form.  Registration is NOT complete until we have received both the electronic registration and full payment in U.S. funds. Benchmark is not responsible for registrants failing to complete the registrations process as described herein. 

Registration and Payment submitted via Mail:   First,  press the white PRINTER FRIENDLY button (at the bottom of the form), THEN complete the form, print the form, and remit with payment. Payments must be made in U.S. Dollars by  cashier's check, money order, company/organization check, or company PO.  Registration is NOT complete until we have received both the registration form and full payment in U.S. funds. Benchmark is not responsible for registrants failing to complete the registration process as described herein. 

Course location:  Unless otherwise noted, courses are conducted at:  Delta Medical Center, 3000 Getwell Road, Memphis, TN. 
Maps and directions are available through Mapquest or similar services. Please contact us if you need a list of area hotels. 

Additional information such as course descriptions and pricing can be found on the Courses page.

 

Registration for the FEB 2012 EMT and Paramedic Refresher Courses is now CLOSED. The class is FULL.

 

Registration is now available for the MARCH 2012 EMT and Paramedic Refresher Courses.

The next refresher courses scheduled are: 24.0 Hour EMT/EMT-IV: NOV 16 & 17, 2012 and the 48.0 hour Paramedic NOV 16, 17 & DEC 7 & 8, 2012. Registration will be available on or around April 1, 2012.

 

Check the box(es) next to the course(s) for which you are registering. 

 

 

To  add  either  the  PALS  add-on  or  the  ITLS  add-on,  go  to  the  Courses  Offered  page  and  look  under  DOT  EMT/PARAMEDIC  COURSE  ADD-ONS,  click  the  appropriate  ADD  TO  CART  tab,  and  follow   directions  to  submit  payment.

 

The EMS Refresher, ITLS, and ACLS activities are approved by the Continuing Education Coordinating Board for Emergency Medical Services (CECBEMS). CECBEMS is the national accrediting body established to develop and implement policies to standardize the review and approval of EMS continuing education activities.The cosponsoring organizations of CECBEMS are the National Association of Emergency Medical Technicians, the American College of Emergency Physicians, the National Association of Emergency Medical Services Physicians, the National Association of State Emergency Medical Services Directors, the National Council of State Emergency Medical Services Training Coordinators, and the National Registry of Emergency Medical Technicians.  For additional information on CECBEMS, go to www.cecbems.org.

Incomplete registration forms will not be processed. If you have not received a non-automated email registration confirmation from us within 7 days of you registring for a course, your registration my not be complete. You need to contact us at benchmarkems@bellsouth .net immediately.

American Heart Association Online Courses
HeartCode BLS Healthcare Provider (CPR) Part 1 - Online
HeartCode ACLS Part 1 - Online
HeartCode Bloodborne Pathogens - Online
American Heart Association CPR Courses
American Heart Association ACLS Courses
ACLS Update (renewal) March 17, 2012 8:00am
ACLS Update (renewal) April 13, 2012 8:30am
ACLS Initial June 8, 2012 8:30am
ACLS Update (renewal) June 8, 2012 5:00pm
ACLS Update (renewal) August 10, 2012 8:30am
ACLS Initial October 12, 2012 8:30am
ACLS Update (renewal) October 12, 2012 5:00pm
ACLS Update (renewal) December 14, 2012 8:30am
American Heart Association PALS Courses
PALS February 18, 2012 8:30am
PALS April 14, 2012 8:30am
PALS June 9, 2012 8:30am
PALS August 11, 2012 8:30am
PALS October 13, 2012 8:30am
PALS December 15, 2012 8:30am
Computer Adaptive Testing (CAT)
Emergency Medical Responder (1st Responder)
Emergency Medical Technician - Basic (EMT-B)
Emergency Medical Technician - Advanced (AEMT)
Emergency Medical Technician - Paramedic (EMT-P)

DOT EMT and Paramedic Refresher Courses

DOT EMT-B/IV Refresher, March 10 and 11, 2012
DOT EMT-Paramedic Refresher, March 10, 11, 16 and 17, 2012

Other Courses

Emergency Medical Responder (EMR)  Initial Course

EMR Initial Course, Dollywood, February 1, 6, 17, 20, 27 and March 5, 7 & 14, 2012 0730 - 1730 hours

 

 

 

ITLS Renewal Course February 11, 2012 Memphis 0800 hours - 1800 hours
ITLS Completer Course February 11, 2012 Memphis 0800 hours - 1800 hours
     To take the Completer Course, participants must complete either the FEB 2012 EMT Refresher or the ITLS eTrauma online portion to take this course. If choosing the eOnline Course, proof of online completion is required by the registration deadline. Go to www.itrauma.org and follow the registration information for the eOnline Provider Course.

NAME as it appears on your certification or license

 * required

Home Phone
(xxx) xxx-xxxx
Do not enter cell or work as home. Enter "n/a" if no home phone.

 * required

Work or Cell Phone
(xxx) xxx-xxxx
Do not use home for work or cell number.

 * required

Email address
Email is our primary means of communication. Please provide a valid email address you will check frequently and take the proper steps to allow email communications from Benchmarkems@bellsouth.net.  Benchmark is not responsible for information not received by course registrants. Edit Text

 * required

Home Mailing Address

 * required

City, State, and  Zip Code

 * required

Gender   (M or F)

 * required

Date of Birth   (MM / DD / YYYY)

 * required

Employer
If registering for a First Responder initial or refresher course, please list the squad/company with whom you are affiliated and not your employer.

 * required

Assignment / Department / Shift
(unit, nights, truck, etc)

 * required

Level of Certification or
Licensure

(MD, PA, RN, NP, EMT-B, EMT-IV, EMT-P, First Responder, etc)

 * required

State of Licensure     
(2 letter abbrev.)

 * required

State Certification / License Number
Please omit the 0's in front of the numbers.
Enter your Certification or License Number and not your renewal number.
Enter "n/a" if not applicable.

 * required

State Certification / License Expiration Date    (MM/DD/YYYY)
Enter "n/a" if not applicable.

 * required

National Registry Number
Enter "n/a" if not applicable.

 * required

National Registry Expiration     (MM/DD/YYYY)
Enter "n/a" if not applicable.

 * required

Method of Payment
Selecting online payment will NOT automatically redirect you to the PaPal page.  After completing this form and pressing the SUBMIT button, please go to the Courses Offered page and follow the instructions on that page.

Online Credit/Debit Card via PayPal
Cashier's Check or Money Order
Company Purchase Order

Before clicking SUBMIT please read the disclaimers and notices below. 

Please update via Email on future Benchmark courses and events.
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AHA DISCLAIMER: The American Heart Association (AHA) strongly promotes knowledge and proficiency in BLS, ACLS, and PALS and has developed instructional materials for this purpose. Use of these materials in an educational course does not represent course sponsorship by the American Heart Association. Any fees charged for such a course, except for a portion of fees needed for AHA course materials, do not represent income to the Association.

COURSE COMPLETION DOCUMENTATION REPLACEMENT POLICY:  Post Course documentation is mailed via U.S. Post Office to the address entered during registration. Post course documentation is presumed to have been received unless returned by the U.S. Post Office. If returned by the U.S. Post Office, the documents will be held until you contact us. A replacement fee of $25.00 per document will be assessed for any reason other than an error on our part. 

COURSE COMPLETION: Course completion is defined as: The participant successfully demonstrated the core knowledge on said date and Benchmark, its faculty, staff, assistants, and agents neither implicitly nor explicitly guarantees any degree of future performance. Therefore, by participating in this activity, the participant hereby indemnifies and holds harmless Benchmark, its faculty, staff, assistants, and agents from any claims that may arise from participation in this activity or activities. The participant furthermore agrees and understands that comprehension and performance is an individual responsibility; that Benchmark does not license or certify individuals in skills or procedures; and that the participant must adhere to local standing orders, protocols, or other medical direction, and within the individual's scope of practice.

COURSE MATERIALS:  Course materials when applicable are usually mailed within 3 - 5 business days of registration completion. Online course codes and instructions are usually emailed within 1 - 2 business days of registration completion.  Benchmark does not accept liability or responsibility for shipments lost or damaged.

PRIVACY NOTICE: Submission of information will be retained for course attendance, participation and reporting as may be required by the course sponsor and or distributor of continuing medical education certificates. This information may be used to notify the participant of future continuing education or training opportunities. Benchmark protects participant personal information submitted against public inspection and disclosure absent a subpoena or for the purposes of health oversight activities as described herein.

REFUNDS/CANCELATIONS:   No refunds will be issued after the course registration has closed.  Courses may be re-scheduled and in most cases without additional payment. The registration fee paid minus a $50.00 cancelation fee will be assessed if the course is canceled before the registration deadline unless course materials have been mailed. If course materials have been mailed, no refund will be issued.    

SUBMISSION:  By submitting registration information and participating in the registered course, you attest that you have read, understand, and agree with the course disclaimers, terms, conditions, and notices, and that you have submitted to the best of your knowledge correct and true information. You also acknowledge that it is your responsibility to notify Benchmark in the event of any change in information within thirty days of such change or in a timely manner to ensure proper notification and or receipt of post course documentation.