Apply for your Course Online

Please fill in the form below to register for a Course with the ATA International Advanced Training Academy

    Applicant Information:

    Please note: all fields marked with a red asterisk (*) are mandatory.



    Please include date qualified and from which institution qualification was obtained

    Contact Information:


    Address:




    Postal Address:




    Special Dietary Requirements:

    N.B. You must select Yes or No below to complete this form

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    ALS Training Academy Course Information

    American Heart Association Programs


    N/ABLS for HCPBLS for HCP Instructor*ACLS*PALS*PEARS*
    *These courses require that you provide details of BLS for HCP certification



    Would you also like to sign up for one of our International Trauma Life Support Programs?

    N.B. You must select Yes or No below to complete this form

    YesNo


    ITLS - basicITLS - Advanced

    Please select a course date, as well as an alternative date
    Note: if you hover your mouse over the two date fields below, a down arrow will appear on each to bring up a calendar for easy date selection.



    Do you have any challenges we need to know about?
    (This information will be kept confidential, but is important to ensure a positive learning experience)
    N.B. You must select Yes or No below to complete this form

    YesNo


    Difficulty With EnglishKnee Or Back ProblemsHearingVisual (Not corrected with glasses/contact lenses)Other (Please Specify)



    ColleagueOwn CompanyFire & Rescue International MagazineAttended PreviouslyFacebookReferred by another organisationEmail/Mail ChimpLinkedInWebsiteFlierWord Of MouthMedpagesVia SMSOther

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