Download - Registration Worksheet The "SUMMIT" Salt Lake City

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www.emsassociates.com

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38th Annual

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The Summit in Salt Lake City

(An EMS and Emergency Services Conference)

!BUNDLE PACKAGES and PreCon Sessions

***ALL PreCon Sessions are held on Wednesday, November 192014

TheComplete Conference (3) Full days, + One PreCon

PreCon Choices are either 4 or 8 hours in length as indicated below !

4 Hour Class Package (choose either AM or PM session) ***BONUS*** the 4 hour package includes the option for you to add, one of the Evening Education Sessions at 50% off the published price of $75.00. This class discount will be applied to your attendee record during registration). ** Advanced Moulage 2.0 (Warner) **Includes Lab Fee ** 12 Lead Interpretation (Made Easy) (Yost) **Includes lecture material ** Airway Interventions and Resources (Bolleter) ** EMS Incident Command-Organizing Chaos (Bouvier) !8 Hour Class Package ** Nursing - Practical Skills Day ** LIVE Fire Training SLC Fire Training Center ** SAVE a COP Tactical Medicine - LEO, EMS, Military

$410.00 (Choose Cutting Edge from the dropdown menu during online registration to receive this pricing)

TheUpgrade Complete Conference (3) Full days

PLUS - (ONE 2hr. EVENING PreCon Session 7-9pm, 11/19) !** IO/IV with Scotty B (Bolleter) ** K9 Emergency Field Care (Dick/Halcome)

$370.00 (Choose Evening Arrival from the dropdown menu during online registration to receive this pricing)

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!Registration WORKSHEET

The Main Conference Only... (3) Full days/NO PreCon (Thursday Saturday)

$295.00 (Choose Main Conference Only from the dropdown menu during registration to receive this pricing)

NOTE:PreCon Session at the class prices listed for each session on the Registration

Worksheet below...be sure that they dont compete for the same time...

BUNDLE PACKAGESConference)

NOTE: If you are purchasing for more than ONE attendee multiply price by # of attendees

**NOTE: If you are responsible for registering more than ONE attendee...please send a separate list

stating which attendee is attached to which PreCon

If paid BY

11/14

If paid AFTER 11/14

Total

The Cutting Edge Packages Select Cutting Edge from the dropdown menu (multiply number of attendees)

$410.00

$450.00

The Evening Arrival Package withPreCon Upgrade

Select Evening Arrival from the dropdown menu (multiply number of attendees)

$370.00

$400.00

The Main Conference Only Package Select Main Conference Only from dropdown menu (multiply number of attendees)

$295.00

$325.00

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**PLEASE NOTE: If you choose to ADD an additional PreCon (AM/PM or evening), you will be charged an additional amount at that

individual PreCon rate. Please enter PreCon Plus as your discount code at the START of

registration. OR... You may choose an A la Carte Option... (Individual selections)

You may pick one, two or even three PreCon sessions (an AM/PM and the evening session)

A la Carte Options***Classes listed below are Wednesday, November 19, 2014

LIVE Fire Training Salt Lake City Fire Hands-on Course (Ladder, Hose, SCBA)

(8hr.) 8-5pm

$185.00

$195.00

Nursing Track Emerging Trends (8hr.) 8-5pm

$185.00

$195.00

Save a Cop (EMS, LEO, Military) Tactical Medicine/Active Shooter

(8hr.) 8-5pm

$185.00

$195.00

12-Lead Interpretation Made Easy

(Includes Training Material) (4hr)

AM Session (8am-12pm)

$150.00

$160.00

12-Lead Interpretation Made Easy

(Includes Training Material) (4hr)

PM Session (1pm-5pm)

$150.00

$160.00

ADVANCED Moulage 2.0 (Includes Lab Fee)

(4hr)


$150.00

$160.00

ADVANCED Moulage 2.0 (Includes Lab Fee)

(4hr)


$150.00

$160.00 !

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!Airway Intervention and Resources Instructor - BOLLETER (4hr)


$175.00

$195.00

Airway Intervention and Resources Instructor - BOLLETER(4hr)


$175.00

$195.00

EMS Incident Command Instructor - BOUVIER(4hr)


$175.00

$195.00

EMS Incident Command Instructor - BOUVIER(4hr)


$175.00

$195.00

**(3) Evening Sessions** November 19thIO Access Skills Bolleter 7pm-9pm $75.00 $95.

00

K9 Emergency Care-Dick/Halcome

7pm-9pm $75.00 $95.00

Operation KIDS Vehicle Restraint and Transport of Children Janet Brooks

7pm-9pm FREE FREE

Individual Conference Day(s) (Thursday, Friday or Saturday)

$185.00

$195.00

Add up all of your selections and total the amounts...

Sub TOTAL:

Utah State Sales Tax add 6.85% (if tax exempt, includea copy of your tax exempt letter or certificate with your registration)

TAX: (6.85%)

Total Registration Amount Total:

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!Last Name: First Name:

Street Address (Include PO Box):

City: State: Zip:

Phone: Work Phone:

E-Mail: EMS Department E-Mail:

Affiliated Title and Agency (Department) Agency Address:

Payment Method (Select Option)

Check Enclosed Make checks payable to: EMS Associates Mail to Framework (address below)

Purchase Order Credit Card

PURCHASE ORDER #(terms = net 30 days)

Company Name:

Billing Address:

E-Mail Address:

City: State: Zip:

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MAIL COMPLETED FORM TO: Framework Meetings and Destinations

Attn: Registration, The "SUMMIT" SLC 2014 2192 E. Grandview Drive Coeur d'Alene, ID 83815

!Cardholder Name:

Billing Address:

City: State: Zip:

Card Number: Expiration Date and CVV code:

Authorized Signature:

Contact Person: Phone:

E-Mail Address (required for credit card payment):

CREDIT CARD PAYMENT

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Download - Registration Worksheet The "SUMMIT" Salt Lake City

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