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2013 greater buffalo ems conference reg form

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John Reardon
John Reardon

This document is a registration form for the 2013 Greater Buffalo EMS Conference being held from May 3-5, 2013 at the Beaver Hollow Conference Center. It provides options for full conference registration, individual sessions, and overnight accommodations. Registrants can choose to attend various educational tracks on different days and also purchase tickets for the Saturday dinner banquet and reserve rooms at the conference center hotel. Payment details are listed at the bottom along with cancellation policies.

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2013 Greater Buffalo EMS Conference Beaver Hollow Conference Center May 3-5, 2013 Registration Form Complete one form per person: Last Name: First Name: Organization: Title: Level: CFR EMT EMT-I EMT-CC EMT-P EMT Number: Email Address (CME certificates/confirmations will be sent here): Phone: Full Conference Registrants: (Complete this section) $160* prior to December 1st ($200* after December 1st ) $ Includes: Friday Session: WMD 7pm-10pm Saturday Session: General EMS Topics (does not include banquet) Sunday Session: (select one) BLS Track ALS Track Instructor Track I wish to attend the Saturday night Dinner Banquet ($40) $ I request overnight accommodations (complete section below) Sub Total: Section 1 $ “Ala Carte” Options: (Complete this section) Friday Session: WMD 7pm – 10pm $35 $ Saturday Session: General EMS Topics (does not include banquet) $85 $ Sunday Session: (select one) $85 $ BLS Track ALS Track Instructor Track I wish to attend the Saturday night Dinner Banquet $40 $ I request overnight accommodations (complete section below) Sub Total: Section 2 $ Overnight Accommodations: (Complete this section) Friday Saturday ($120 each night) x x $120= $ #of Rooms #of days Name on the room: Number of People per room: Sub Total: Preference: King Bed Two Double Beds Section 3: $ *Price does not include dinner banquet or overnight accommodations TOTAL: $ Make checks payable to: Office of Prehospital Care 462 Grider Street; Buffalo, NY 14215 All Refunds will be processed less a $25 admin fee / registrant. Beaver Hollow may charge an additional fee for cancelled rooms.

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2013 greater buffalo ems conference reg form

  • 1. 2013 Greater Buffalo EMS Conference Beaver Hollow Conference Center May 3-5, 2013 Registration Form Complete one form per person: Last Name: First Name: Organization: Title: Level: CFR EMT EMT-I EMT-CC EMT-P EMT Number: Email Address (CME certificates/confirmations will be sent here): Phone: Full Conference Registrants: (Complete this section) $160* prior to December 1st ($200* after December 1st ) $ Includes: Friday Session: WMD 7pm-10pm Saturday Session: General EMS Topics (does not include banquet) Sunday Session: (select one) BLS Track ALS Track Instructor Track I wish to attend the Saturday night Dinner Banquet ($40) $ I request overnight accommodations (complete section below) Sub Total: Section 1 $ “Ala Carte” Options: (Complete this section) Friday Session: WMD 7pm – 10pm $35 $ Saturday Session: General EMS Topics (does not include banquet) $85 $ Sunday Session: (select one) $85 $ BLS Track ALS Track Instructor Track I wish to attend the Saturday night Dinner Banquet $40 $ I request overnight accommodations (complete section below) Sub Total: Section 2 $ Overnight Accommodations: (Complete this section) Friday Saturday ($120 each night) x x $120= $ #of Rooms #of days Name on the room: Number of People per room: Sub Total: Preference: King Bed Two Double Beds Section 3: $ *Price does not include dinner banquet or overnight accommodations TOTAL: $ Make checks payable to: Office of Prehospital Care 462 Grider Street; Buffalo, NY 14215 All Refunds will be processed less a $25 admin fee / registrant. Beaver Hollow may charge an additional fee for cancelled rooms.