Newport Registration

2012 Newport EMS Conference

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REGISTRATION FORM
2012 Newport EMS Conference

First Name         Last Name          Phone

Address            Fax

email            EMT Level

City State Zip

Agency Purchase Order Number

Address

Phone

City State Zip


Thursday workshops APRIL 7, 2011
Medical and Trauma Scenarios Hands On	$ 60
SportMedic	$ 100
BRAVO Game Show	$ 60
PALS Renewal	$ 150
Crew Resource Maanagement	$ 80
Leadership for the Up and Coming	$ 80
	$ 0
Friday workshops APRIL 8, 2011
ICLS	$ 100
High Fidelity Manikin Simulation Lab Morning Session	$ 80
High Fidelity Manikin Simulation Lab Afternoon Session	$ 80
Pediatric Medical and Airway Skills	$ 60
Pediatric Assessment and Trauma Skills Workshop	$ 60
ACLS renewal	$ 1500
	$ 0
Conference (saturday & sunday) APRIL 14-15, 2012
Conference	$ 150
Conference with Short Sleeve T-shirt	$ 160	Size
Conference Clothing
Additional Short Sleeve T-Shirt	$ 10	size (S/M/L/XL. XXl)
Additional Short Sleeve T-Shirt	$ 10	size (S/M/L/XL. XXl)
Long Sleeve T-Shirt	$ 15	size (S/M/L/XL. XXl)
Long Sleeve T-Shirt	$ 15	size (S/M/L/XL. XXl)
Hooded Sweat-Shirt	$ 30	size (S/M/L/XL. XXl)