PALS NEPD Payment Form- FOR NURSES ONLY

CNMC NURSES ONLY can use this form to apply for a promo code for AHA Class Registration. If you are taking the BLS Employee marathon, no promo code is needed.

If you've previously applied for a promo code and have a problem with your application, please email Brandi Elliott- bnelliott@cnmc.org.

Upon submission, this form is emailed to Simmy King. Once approval is received from Simmy, the submitting RN will have a promo code sent to their CNMC email from Valerie Clarke. The promo code can then be used during class registration for any PALS class at www.childrensnational.org/PALS. If you are taking a unit based class, please contact your educator for your class registration link.

If you have questions, please contact the PALS Program at PALSProgram@childrensnational.org.

Name Name First Last
Email (MUST BE YOUR CHILDREN'S EMAIL) *
What class date are you interested in? What class date are you interested in? / MM / DD YYYY
What department do you work for? *
Your employee ID number: *
What class do you want to take?
If your course isn't listed, NEPD doesn't sponsor that class. Please reach out to PALSProgram@cnmc.org for payment options.

What class do you want to take?
If your course isn't listed, NEPD doesn't sponsor that class. Please reach out to PALSProgram@cnmc.org for payment options. PALS Initial + BLS Renewal PALS Renewal + BLS Renewal Unit Based PALS Initial + BLS Renewal Unit Based PALS Renewal + BLS Renewal PALS + BLS Instructor
Draw your signature into the box below to show agreement to the following terms.

Students enrolling in any PALS Program course agree to abide by the current Children's National Medical Center PALS Program and Training Center Refund Policy. Cancellations or rescheduling requests will be honored only if received 14 days prior to the first day of the scheduled course. Only one rescheduling request will be honored, after which the participant will pay out-of-pocket for subsequent fiscal year registrations. All refunds will be subject to an administrative cancellation fee. Students that do not cancel their registration and do not show up to class will not receive a refund and will not be permitted to change their registration. I understand that cancellation or rescheduling of my enrollment in a course within 14 days of the course start date will require me to pay the course tuition fee. *

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
I am an RN.
If you cannot check “yes,” you may not apply for a promo code via this form. Please use the payment form located at childrensnational.org/pals

I am an RN.
If you cannot check “yes,” you may not apply for a promo code via this form. Please use the payment form located at childrensnational.org/pals Yes