National Association of State EMS Officials

Annual Meeting Pre- Registration Form

September 23-27, 2012 ● Grove Hotel and Boise Centre ● Boise, ID

Program:
Posted at www.nasemso.org
Registration Fee:
$55 (Sunday-Leadership Skills)
$435.00 ( Mon-Thurs. Program)
$150.00 spouse/guest
Partial Rate: $150 per day Mon – Thurs.
Fee Includes:
Handouts, breaks, lunches (2), and reception (1)
Accommodations:
The Grove Hotel
245 So. Capitol Blvd.
Boise, Idaho
Rate is $119 + tax
Reservations:
Phone: 1-888-961-5000
Reference NASEMSO to secure the $119 single/double rate)
Online: Click online booking; type in the attendee code: EMS
NASEMSO’s rate will be available until 8/23/12, or until the NASEMSO room block is sold out.
Transportation:
The Grove Hotel (4 miles from the airport) provides complimentary shuttle service to/from the Boise Airport. The shuttle runs approximately every 15 minutes. Please use the courtesy phone next to baggage claim. / Who should attend: Members of NASEMSO and other state and federal officials with a role in emergency medical services and EMS suppliers. The NASEMSO Annual Meeting purpose is to address current issues and trends in emergency medical services systems.
For more information: 703-538-1799 www.nasemso.org
Select your registration:
payment mailed separately
please invoice me
please use credit card
Amount :
Council Meetings:
Are you planning to attend the forum for:
state EMS directors
data managers
education and prof. standards
medical directors
pediatric emergency care
trauma managers
Partial Registrants ONLY (please check each day that applies):
Sunday (Leadership Skills)
Monday
Tuesday
Wednesday
Thursday
Optional Activities:
Social Outing-Coolwater Creek Ranch – please use the outing sign-up form to register for this optional activity.
PLEASE NOTE:
The Leadership Skills Program will be offered Sunday, Sept. 23, 10 am to 6 pm. Designed for new state officials, experienced members are also welcome. For more information, click Leadership Skills Agenda. / Name: Nickname:
Title:
Organization:
Address:
City/St/Zip:
Phone: Fax:
Email:
Spouse/Guest: Nickname:
Payment Check (payable to NASEMSO – U.S. funds only)
Method: Purchase order
Visa MasterCard AmEx
Name on card:
Card number:
Security Code (located on the front or back of the credit card)
Exp. Date: Signature:
Credit Card Billing Address:
Cancellations received 14 days prior to the event will be granted a 50% refund. No refund or credit will be granted for requests received less than 14 calendar days prior to the event. If you do not cancel your registration in writing and do not attend, full fees are due; you may however, send a substitute in your place. Participation in NASEMSO events and all associated activities is at individual’s own risk.
Fax, mail, or email this form to:
NASEMSO ● 201 Park Washington Ct. ● Falls Church, VA 22046
Fax: 703-241-5603 ● Phone: 703-538-1799