31st annual conference
EMS Conference August 14-16, 2008 • Holiday Inn Harrisburg/Hershey • Pre-Conference Workshops August 12-13, 2008

Registration Info and Form

PEHSC 600 Wilson Lane Suite 101
Mechanicsburg, PA 17055
Questions? Call 800-243-2EMS (in PA) or (717) 795-0740 or email: pehsc@pehsc.org

Sex M F
Name
First
Last
Phone
(Day)
(Evening)
Address


City
State
Zip
County of Residence

HOW TO REGISTER
1. Complete the entire form. You may also print out the form (one per individual) and mail it, along with payment, to: PEHSC, 600 Wilson Lane, Suite 101 Mechanicsburg, PA 17055. Click here to print the online form.
2. Payment information must accompany all registrations; Purchase orders will NOT be accepted for payment.
3. Please do NOT mail any registration forms after July 31, 2008. After July 31, 2008, please bring the registration form with you to the conference registration desk.
4. No refunds will be awarded after August 1, 2008.
Organization
Title
E-mail Address
  Confirmation letters will be sent electronically to the email address provided. If you need a hard copy, please contact PEHSC directly.
EXTREMELY IMPORTANT INFORMATION:
Certification: (check your highest certification level only please)
First Responder RN PHRN
EMT HP-Physician
Paramedic Other
 
Please insert your certification ID# below. Please make sure you list the appropriate ID # for con ed credit accrual. Incomplete and incorrect #s may delay your con ed credit processing.
ID #

A. Preconference Sessions
(Walk-in registrations for Preconference will not be accepted)
August 12 - 13, 2008    
ACLS for EMT - Basics $100.00  
BLS CPAP Train the Trainer $75.00  
EMS Best Practices $100.00  
Advanced Burn Life Support $100.00  
EMS Operations at the Fire Scene $75.00  
EMS Self Sufficiency for Disasters $75.00  
Introduction to Farm Emergencies $150.00  
BLS CPAP Train the Trainer course is full. Please choose an alternative course.

B. General Conference

August 14 - 16, 2008    
1.
 Full Conference  
 
Entire Conference

$200 - On or Before July 31, 2008
$225 - After July 31, 2008

   
 
 
I will attend Saturday's clinics
  
2.
 One Day Only  
   
For Thursday or Friday Only
$110 - On or Before July 31, 2008
$130 - After July 31, 2008

For Saturday
$90 - On or Before July 31, 2008
$110 - After July 31, 2008
 
Select Package: pick one
  
 
Thursday
  
 
Friday
  
 
Saturday
  
 
For our planning, please tell us the following:
I plan to attend lunch on Tuesday as part of my preconference package
I plan to attend lunch on Wednesday as part of my preconference package
I plan to attend lunch on Thursday as part of my preconference package
I plan to attend the awards lunch on Friday as part of my conference package
I DO NOT plan to attend the awards lunch, but would like an alternate lunch on Friday
I plan to attend breakfast on Saturday
I DO NOT plan on attending any of the meals during the conference
**You must be a registered participant on the specific day to receive lunch at no charge. If you fail to select an option, we will assume you are eating lunch on your own.
       

C. Special Events

1.
 Annual Golf Tournament 12:30 p.m. (Wednesday)
 
$65/player ($250 for a group of 4) - Number of players
  Names of Team Members:  
 
 
2.
 Additional Annual EMS Awards Banquet 12:00 pm (Friday)
   
$35/person - Number of persons
3.
 Hershey Park Tickets
   
$23.50/child (ages 3-8) - Number of persons
   
$33.50/adult - Number of persons
   
$23.50/senior (ages 55+) - Number of persons
4.
 I will attend the EMS Strike Team Drill & Demonstration Tuesday    Wednesday
       

Registration confirmation letters will be mailed to you. Please bring this info with you to the pre-registration line at the conference desk. REMEMBER...payment must accompany registration. Do not mail registrations after July 31, 2008. If after July 31, 2008, bring the registration with you to the door.


EMS Conference August 14-16, 2008 • Holiday Inn Harrisburg/Hershey • Pre-Conference Workshops August 12-13, 2008