Clinical Cardiology Course Application Form

Clinical Cardiology Course/Exam Application & Registration

* Indicates required field

Will you be taking one of our Cardiology Exams at the conclusion of this Course? *

Yes No Undecided

State Issued Valid ID Required - Scan and submit with application to blucido@accn.net *

Exam of Choice *

Reason for Taking the Clinical Cardiology Course: *

Name *

First

Last

Gender *

If you Selected Other Status, Please Identify *

Provide your Professional NP or PA License Number *

State Where License Issued *

Identify Certifications Currently Held *

Home Mailing Address Including Apt. or Unit number *

City *

State or Province *

Zip Code or Country Code *

Country of Residence *

Home Phone - Cell Preferred (include area code) *

Work Phone (include area code) *

Private Email Address *

Work Email Address *

Name of Employer: example: St. Joseph's Hospital of Brookville *

Area of Cardiology Employed in. *

Supervisor Name and phone number *

Length of Time Working in Cardiology Areas *

How did you Learn Cardiology? *

College Course Seminars and Workshops My Hospital Supplied the Needed Training I learned on the job and am self taught

Identify any personal special needs that we need to consider during the Course and/or Exam. *

How did you learn about the ABCM's Courses and Certification Exams? *

TERMS OF USE: May sign into the Course Modules on a PC or MAC, tablet, or smart phone. You may watch each recording 2 times and can rewind and go forward to repeat items. Should you need additional viewings, you will have to pay a small retake fee. Please do not share your link for this course with anyone or you will be billed again for the course as well as the person who logged in using your registration. By stating yes you agree to abide by our terms of use. *

Submit

2020 Clinical Cardiology Sessions Available:

Session 1: December 10, 12pm-5:10pm
Session 2: December 11, 12pm-5:10pm
Session 3: December 12, 12pm-4:51pm
Session 4: December 13, 12pm-4:00pm

Type in "Key" words to find what you are looking for on our site.

Contact Information:

Mail: ABCM, Inc, P.O. Box 5929 Sun City Center, FL 33571
Phone: 813-812-7222 (M-F 9am to 4pm - except major holidays)
Course and Exam Director: Jonni Cooper - jcooper@abcmcertification.com
Membership Director: Kayla Bryant kbryant@accn.net
Course Registrar: Bobbi Lucido blucido@accn.net
©2021 ABCM, Inc. All rights reserved.