1. Opportunity to sit for the National 12-Lead ECG Board Certification Exams Onsite. With Jonni Cooper Recording, Reading, and Responding Houston, TX April 25, 2016

2. Registration Fees and Instructions for the 12-Lead ECG Course and/or ECG Certification Exams: Course Fees: $150 for Non-Members of the ACCN or SCM, and $127.50 for Members of ACCN or SCM. It pays to join one of these two organizations. Nurses join the ACCN and CMTs and Techs join the SCM… Exam Fees are Separate and Optional: $150 for Non-Members of the ACCN or SCM, and $127.50 for Members of ACCN or SCM. You may decide onsite if you wish to take one of the Board Certification Exams and pay onsite once you decide. Pre-Registration fee for the Course Only is a must to reserve your seat and handout, and is due by April 5 th, 2016. Any registrations received after this date will be assessed a $20 late fee and will be considered a walk-in registrant. Payment Methods: 1. Pay Online with a credit card at www.accn.net under Conference Calendar, then scroll down to this Course and date. 2. To Pay by check or money order, make payable to ABCM (may combine Course and Exam fees in one, or separate checks) and mail along with the Registration Form on the next page to: ABCM, P.O. Box, Spring Hill, FL 34611 3. Do not mail your Course Registration fee after April 1 st to assure safe arrival by April 5 th. If you register later than the 5 th, please email us of your intent to attend the Course (keeping in mind, you will be considered a walk in after April 5 th and will have to pay the late fee of $20 extra if you miss this deadline. Send emails to: jragan8@tampabay.rr.com 4. If you are undecided about the Exam, you may wait to pay for it onsite with cash or check. We do not process credit cards onsite due to time constraints.www.accn.net jragan8@tampabay.rr.com Course Schedule: 7:30am Registration 8:00 am to 4:30 pm  Introduction to the Normal 12-Lead ECG,  Calculating the Electrical Axis,  Right & Left Bundle Branch Block,  The Hemiblocks  Identification of Ventricular Arrhythmias vs SVT with Bundle Branch Block,  ACS: STEMI, NSTEMI, and Unstable Angina  Emergency Level Electrolyte Disorders 5:00pm – Optional 12-Lead ECG Certification Exams CE Awards: This course is approved for 7.0 contact hours for by the Florida Board of Nursing Provider Number 50-14076. Course Location: Best Western Plaza Hotel & Suites, Medical Center Area - 6700 Main St, Houston, TX 77030 Course Faculty: Jonni Cooper, RN, MACCN, A-ECG-BC, CVRN-BC, CEO/President & Founder of the American Board of Cardiovascular Medicine, Home of the Marriott Heart Foundation (MHF), American College of Cardiac Nurse Practitioners (ACCNP), American College of Cardiovascular Nurses (ACCN), and the Society of Cardiac Monitoring (SCM). Jonni is a seasoned Author, International Faculty and Guest Speaker for Hospitals and Cardiology Organizations Worldwide. One participant stated that she should be cloned so everyone could have her in their unit. When you join her interactive course, she will not only motivate you, but she will provide you with the diagnostic tools essential to your cardiac monitoring practice. She will be using the i-clicker audience response system where each participant will have a hand held device that allows them to respond to the ECGs presented. This makes for a fun and lively interaction between participants and faculty, and allows each person to know just how well they are reading ECGs.

3. Program Registration 12-Lead EKG Course – Houston, TX 7:30am to 4:30pm Optional ECG Certification Exams at 5:00-6:00pm Please do not leave any questions un-answered, or your registration will not be complete. Print clearly in your best handwriting.  I will attend the 12-Lead ECG Course  I will sit for my 12-Lead ECG Board Certification Exam at the completion of the Course  I am undecided about taking the Exam and will let you know onsite at the Course. 1. First name: ______________________Middle initial: _____ Last name: ____________________________ 2. Degree(s) Held if any: _______________________________________________________________ 3. Professional certifications held: __________________________ 4. Nursing or other Professional License Number & State Issued: _____________________________ 5.  Male  Female 6. Home address: ____________________________ City: __________________ State:_________ Zip: ________ 7. Home email:___________________________________ 8. Work email: ___________________________________ 9. Home phone: ______________________ 10. Supervisor’s Name: ______________________________________ 11. Name of Employer: ______________________________________ 12. Phone number of Employer: ________________________________ 13. What area of cardiology do you work in? ______________________ 14. How long have you worked in this area? ________________ 15. What other areas of cardiology do you have experience in? ____________________________________________ 16. How many hours per week do you work in cardiology? ________ 17. Have you had formal training in cardiology? __________ 18. If so, what specialty degree or certification do you hold in cardiology? ___________________________________ 19. Does your hospital have an in-house training program for cardiovascular critical care and telemetry nurses? _______ 20. Does your hospital have an in-house training program for cardiac monitor and EKG Techs? ____________ 21. Is your hospital a Magnet facility or are they seeking Magnet status? ______