25th Annual Southern Regional EMS Conference Registration Form

First Name:           Last Name:

Address:

City:      State:         Zip Code:

Phone Number (include area code):         Email Address:
 

Please register for one of the following:

General Conference: Starts Wednesday at 11:00 am through Friday at 12:00 pm
EMT - all levels $100.00
Nurse - $125.00 (hour for hour con. ed. awarded

National DOT Basic Refresher Course: Tuesday, May 6 & Wednesday, May 7 (does not include meal ticket for Thursday)
EMT - $65.00
Nurse - $95.00 (hour for hour con. ed. awarded

Intermediate EMT Refresher Course: Tuesday, May 6 through Thursday May 8.  Includes lunch for Thursday
EMT - $105.00
Nurse - $120.00 (hour for hour con. ed. awarded

Paramedic Refresher Course: Tuesday, May 6 through Friday, May 9.
Paramedic - $115.00
Nurse - $150.00 (hour for hour con. ed. awarded
 

Please add your pre-conference workshops:

Pre-Conference Workshops:
EVOC Refresher Course - $25.00 - Monday, May 5 - 1:00 pm - 5:00 pm
Module 1 - $50.00 - $50.00 - Monday, May 5 - 9:00 am - 5:00 pm
 

Additional Meal Tickets:
0 1 2 3 4 - $35.00 each