Secondary Alignment Application


Name:  

Phone Number:  

Mailing Address:

Email Address:  

Discipline:

Expiration Date:  

  • Alignment:
    • To complete your secondary alignment, we need you to secondary align with LifeTek through the AHA's Instructor Network.  Please visit the following website to align: www.ahainstructornetwork.org.  Once signed in, go to ‘edit my profile’ and under the ‘alignment’ tab, make sure you choose LifeTek, Inc as your Secondary TC under your instructor discipline(s). You can look us up by our TC ID, which is WA15093 or simply search "LifeTek".
  • Current Copy of Instuructor Card(s)
    • Please submit copies of the front and back of your current Instructor Card with this form.  Every two years you will be required to renew your Instructor Card with your Primary TC and submit an updated card.  Failer to submit a current card will result in deactivation of secondary alignment.
  • 2015 Instructor Science Update Certificate of Completion*
    •  Please submit copies of your 2015 Instructor Science Update Certificate of Completion for each dicipline you are requestion secondary alignment. *If you became an instructor after 1/1/2016, this may not be required.
  • LifeTek Responsibilities Agreement
    • Please review, sign and submit LifeTek Responsibilities Agreement with this form.
  • LifeTek Carlson Instructor Reference Packet
  • Secondary Alignment Fee:
    • BLS/HS - $45, ACLS/PALS - $55.  Per disipline, every two years (based off your instructor card expiration).

Once all the above requirements are met you will receive an email from LifeTek’s TCC with your entire log in information.

By signing below, I have read, understand and agree to follow all of the requirements outlined above.

Date Signed: November 29, 2020

Leave this empty:

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Signed by Sylvia Thompson
Signed On: November 4, 2020

Signature Certificate
Document name: Secondary Alignment Application
lock iconUnique Document ID: c94c8092b8a506128dd42841b8760467c0ec1cb2
Timestamp Audit
October 22, 2020 2:17 pm MSTSecondary Alignment Application Uploaded by Sylvia Thompson - southsound@lifetekinc.com IP 174.126.133.26