<p>Neonatal Resuscitation Program Registration Form</p><p>The course is taught with interactive learning modules and simulated patients. You need to wear scrubs or attire you wear to work. </p><p>Participant Information Full Name: Department and Mail Code: Address (if non-OHSU): (where you want the card mailed) E-mail Address: Classification ( please select one):  MD RT RN  Advanced Practitioner  Other: ______Class Date:</p><p>We’d like to know a bit more about your learning needs to tailor the class to best suit you. Please describe where you will be practicing and using NRP, your history with NRP, and what you are hoping to get from the course (any specific skills you would like to focus on): ______</p><p>Class Information Please select the appropriate course:</p><p> Provider $200.00 This course if being offered for those who need to undergo initial NRP certification.</p><p> Renewal $120.00 Required: a current NRP card to sign up for this course. This course is being offered for those who are currently certified as NRP provider in order to maintain provider status (status expires every 2 years).</p><p> Instructor $200.00 Required: a current NRP card to sign up for this course. This course is being offered for NRP providers with current provider status.</p><p>Payment Information</p><p>Payment is required. Please send in your registration to Katy Campbell at Mail Code: CDRCP to be added to the roster. Account String to which the charge should be applied:</p><p>Fiscal Authority Name and Phone Number (printed):</p><p>Fiscal Authority Signature: Non OHSU participants: Please make checks payable to OHSU Department of Pediatrics. You can submit your payment at the time of the course to the Lead Instructor. Prerequisite: AAP Written Evaluation Tool Return Pg. 1 of form to Katy Campbell at: Mail Code CDRCP or 707 SW Gaines St. Portland, OR 97239 The AAP has developed an online evaluation for the NRP. When you feel that you have mastered the required lessons; use the PIN number given to you by your division Program Coordinator. If you do not have one, you will need to purchase a PIN online for about $25. Once registered for the evaluation you have 14 days to complete these lesson evaluations. http://pediatrics.examweb.com/pediatricsLogin/index.cfm</p><p>Required: You must complete this before taking your Certification or Recertification class. Please bring printed verification of your completed modules to class for your instructor.</p><p>NRP Book</p><p>Most training programs provide a copy of the NRP book. If you need to purchase a copy, the NRP book is available at the OHSU bookstore 503-494-7708 for $49.95. If they are out, they can order it for you but it takes about a week. After May 2011, you will need to use the 6th Edition book.</p><p>Locations (please see Confirmation Email)</p><p>Children’s Development and Rehabilitation Center (CDRC) 3rd Floor, 3200 707 SW Gaines St. Portland, OR 97239 </p><p>Driving to CDRC? http://maps.google.com/maps?f=d&source=s_d&saddr=45.502918,-122.688382&daddr=45.495894,+-122.685732&geocode=FcZRtgIdguyv-A%3BFVY2tgId3Pav- A&hl=en&mra=ls&sll=45.519605,-122.678075&sspn=0.071084,0.130978&ie=UTF8&ll=45.499745,-122.687888&spn=0.008889,0.016372&t=h&z=16 Parking information:  CDRC South Parking Lot (located across the street): buy a parking pass at the bottom of Terwilliger as you head up OHSU Marquam Hill. It is $7 for 4 hours or $11 for full day; they take cash or credit/debt.  Sometimes metered parking is available on Gaines Street. They charge $1.60 an hour with 3 and 5 hour meters. </p><p>OHSU Simulation and Clinical Learning Center (SCLC): ADP Building 2525 SW 1st Ave; Suite 100 Portland, OR 97201 For immediate questions: Laurie Youker 503-494-0132; Jesika Gavilanes 503-494-0003 Cell: 503-317-4260</p><p>Driving to the SCLC? http://maps.google.com/maps?hl=en&rlz=1T5GGLL_enUS274US275&resnum=0&q=2525+SW+1st+Ave,+Portland,+OR+97201,+USA&um=1&ie=UTF- 8&sa=X&oi=geocode_result&resnum=1&ct=title Parking information:  ADP Building Parking (located under the ADP building): for more than 30 minutes, they charge $3.50/hr for the first 3 hours, with maximum charge of $10.00.  Marquam II Lot (located just past the HR building as you drive down Arthur): If you have an OHSU campus parking sticker, you may park in the lot for free. You can also purchase a pass on the OHSU campus.</p><p>Taking the bus? http://www.trimet.org</p><p>Taking the shuttle? http://ozone.ohsu.edu/parking/campus_shuttle.pdf</p><p>Please e-mail Dr. JoDee Anderson at [email protected] with any questions/concerns or contact Katy Campbell at [email protected] or 503-494-2613 for class dates/times/locations, etc. </p><p>Return Pg. 1 of form to Katy Campbell at: Mail Code CDRCP or 707 SW Gaines St. Portland, OR 97239</p>