IASSH - Excellence in Medical Training

Course Registration Form

Personal Information

First Name *

Last Name *

Email Address *

Phone Number *

Date of Birth *

Gender *

Professional Information

Profession *

Years of Experience

Specialty/Area of Practice

Professional License Number

Current Institution/Employer

Course Selection

Select Course(s) *

Simulated Participant (SP) Training

Task Training Program

Team Training and Crisis Resource Management (CRM)

Preferred Start Date

Payment Information

Payment Method *

Additional Information

Emergency Contact Name *

Emergency Contact Phone *

Medical Conditions or Allergies

Additional Comments or Questions

I agree to the Terms and Conditions and Privacy Policy. I understand that registration is subject to availability and confirmation will be sent via email.

I would like to receive updates about new courses, research papers, and events from Healthcare Simulation Skills.

Registration Information

📋 Registration Process

Step 1: Complete the registration form above

Step 2: Receive confirmation email within 24-48 hours

Step 3: Submit payment or provide billing information

Step 4: Receive course materials and schedule

Step 5: Attend your scheduled training sessions

💳 Payment Options

• Credit/Debit Card (Online)

• Bank Transfer

• Institutional Billing

• Payment Plans Available

• Group Discounts (5+ students)

Contact us for corporate training rates

📞 Need Help?

Registration Office:
📞 9694490440
📧 iassh2025@gmail.com
🕒 Monday-Friday: 9:00 AM - 5:00 PM

Our team is ready to assist you with any questions about courses, scheduling, or payment options.

Frequently Asked Questions

What are the prerequisites for ACLS and PALS courses?

Current BLS certification is required for all ACLS and PALS courses. You must also have a healthcare professional background or be currently enrolled in a healthcare program.

Can I register for multiple courses at once?

Yes! You can register for multiple courses using the same form. We offer package discounts for students enrolling in three or more courses.

Student Registration