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2019 Geneva Convention EMS Conference
Registration Form
Copy, Print out and Register

Geneva Convention 2019

Participant Registration

Name ______________________________________

Address ___________________________________

City _______________________________________

State ____________ Zip Code _______________

Phone  _________________________________

Email______________________________________

Organization_______________________________

q       EMT-B/I  q       EMT-P   q       RN PA

I am registering for Pre-Conference:    _____YES        _____NO

 

 Pre-conference Thursday, March 28, 2019

 Trauma Care Skills Lab

 10:00am - 4:00pm ($50.00) 

Space is limited 

 

 Trauma Care Skills Lab is not included in the conference fee.

 _______________________________________________________________________

I am registering for the following days/whole conference:   

 

q  Friday, March 29, 2019 ($155.00)

q     Saturday, March 30, 2019 ($155.00) 
q     Sunday, March 31, 2019 ($100.00)
q     Full Conference ($330.00)
q     Early Bird Registration ($305.00) 
 
*Early bird registrations must be received by March 1, 2019.
A minimum of $50 must be included with your registration to reserve your spot.

Return completed registration form for each attendee & fee to:

EMSed                                                                                                  

6278 North Leona Avenue 

Chicago, Illinois  60646                        

773-456-0898 (admin) 
                    
Make checks payable to:      EMSed