Please complete the following information and click the Send button at the bottom to send the form securely.
If you have any questions or need assistance, please call us at (865) 269-4616.
We also have an offline PDF version of this form, if you prefer to print and fax back to us.
Click Here for our PDF Form. Fax back to (865) 269-4613 or you can edit the form, save and email back to email@example.com
Name of Facility: (required):
Mailing Address (required):
Course Facilitator Name (required):
Course Facilitator Phone (required):
Email Address (required):
Mail Moderate Sedation Certification Certificates to: Facilitator (address above)Participants
*COURSE FACILITATOR IS THE CONTACT PERSON FOR SEDATION CERTIFICATION. COURSE FACILITATOR WILL GIVE INSTRUCTIONS AND ENROLLMENT KEY TO ELIGIBLE PARTICIPANTS.
CERTIFICATION IN MODERATE SEDATION FACILITY PURCHASE AGREEMEMENT is an online self-study training which awards 10 CE Credits including 6 Pharmacology CECs for RNs and LPNs (physicians category 2 CME’s are available)
- One facility hardcopy with 5 DVDs and a 4 Hour Competency Study Manual
- Intra-op Bio-Rhythmic Music CD for patient listening.
- Moderate Sedation Simulator Demo with 12 patient scenarios
RNs upon successful first time completion of the certification exam receive a one year complimentary membership in the AAMSN. Membership fees $65.00 annually.
The Copyright owner Michael R. Eslinger gives permission to the purchaser the right to use the Moderate Sedation Certification ProviderDirected Independent Study (PDIS) with the following agreement:
• Usage agreement is in effect for two years from date of purchase
• Duplication of course materials for registered users approved for use by above purchaser only.
• Each application requires a copy of professional license and current ACLS and/or PALS
• Certification is available to RNs, MDs and others licensed to give sedation
• LPN's may take the workshop for CE Credit’s only and receive a Certificate of Training
The purchaser may use the Moderate Sedation Workshop free of royalties and commission in exchange for a signed purchase agreement. Agreement is approved for two years from purchase date for up to 1525355075100 Participants based on number of seats at a purchasing fee of $. (See Fee Schedule below)
The purchaser agrees not to sell to or share the Sedation Workshop or copies of the workshop with others separate from this agreement at any time, in any form (mechanical, or electronic).
This agreement is non-transferable. No part of the workshop materials may be used in any manner after the agreement expiration date without a renewed purchase agreement.
The person signing this document is the contact agent or representative of Facility Name agrees to the terms and conditions on this agreement.
By typing your Full Name, You agree to the terms
Individual on-line tuition is $200 Individual DVD tuition is $250
Prices subject to change without notice.
Click here to purchase Online
or Call Healthy Visions Education at 1-866-312-3159 to pay over the phone.
or Complete the following info to purchase, if you have not yet purchased online or by phone.
Number of participants: 1525355075100 (See Fee Schedule above)
Payment Method: Credit CardCheck
Credit Card: VisaMaster CardDiscoverAmerican Express
Amount Enclosed/Bill to Credit Card: $
Credit Card Number:
CVC (Security Code):
Type your Full Name