SMEMSIC 59th Professional Development Conference Attendee Registration
"A Lasting Value"
The online registration form is available below. Please to view session descriptions.

Please provide the following information. Do not hit the enter key on your keyboard while completing the form or the form will be submitted before you are complete. Use the tab key or your mouse to navigate through the form. * indicates a required field:

Contact Information
Please enter the attendees information below.

First Name*

Last Name*

Company

Address*

City*

State*

Zip / Postal Code*

Home Phone*

Work Phone

E-mail*

Fax

Instructor Information

Please select the EMS Region you live or work in from the list below.

Michigan Region 1
Michigan Region 2
Michigan Region 3
Michigan U.P.
Other

Main Conference Fee Information

Please select your type of conference registration. *You must Select one.

3 day member conference registration - $195
3 day member senior conference registration (60 years of age or older) - $155
3 day non-member conference registration - $225
Late 3 day member registration after 9/30/08 - $220
Late 3 day non-member registration after 9/30/08 - $250
1 day member conference registration - $95
1 day non-member conference registration - $110
Late 1 day member registration after 9/30/08 - $120
Late 1 day non-member registration after 9/30/08 - $135
Preconference only - Select course below

If you selected a one day registration, please select which day you will be attending.

Friday
Saturday
Sunday

Pre-Conference Workshop Fee Information
The Pre-Conference workshops are not included in the main conference fee.

Please select the pre-conference sessions you wish to attend on Thursday October 9. These fees are in addition to the above conference fees.

Member ASLS Workshop (8am - 6pm) - $85
Non-Member ASLS Workshop (8am - 6pm) - $130
Member Competencies by Video Workshop (1:00pm - 5pm) - $45
Non-Member Competencies by Video Workshop (1:00pm - 5pm) - $90
I will not be attending a pre-conference workshop

Additional Conference Items

Please select all that apply.

Renew my membership for remainder of 2008 - $30
Main Conference Companion Lunch & Break registration - $55
Companion name
Friday Afternoon Member/Exhibitor Reception - Free

Conference Breakout Sessions
Please select a breakout session for each of the days listed below. These sessions are included with the main conference registration fee.

Saturday Ocboter 11, 2008 3:30pm - 5:30pm

Session A; No More Skills Sheets!
Session B; Enhancing Teaching Effectiveness in EMS and Fire
Session C; Simulation for EMS Education
I will not be attending a Saturday breakout session

Sunday October 12, 2008 8:30am - 10:30am

Session D: Moulage
Session E: Games in the Classroom
I will not be attending a Sunday Breakout session

Payment Information
*Please select your method of payment below. You will be given specific information for mail or credit card payment after you submit this form. A $10 processing fee will be charged for registrations reserved with the purchase order method. If you choose to pay by credit card, you will be asked to enter your registration selections on the payment form to calculate your total payment after you submit this form.

Please remember that we will be having a Friday afternoon member/exhibitor reception for conference attendees. If you wish to attend the reception, you must have a ticket which can be obtained for free by selecting that option under additional conference items above.

I will be mailing a check for my registration fees.
My organization will be submitting a purchase order. Please invoice me at the above address. $10 additional fee
I will be paying by Credit Card.
I am a speaker at the conference and my contract states my registration fee is waived.

Comments or Questions

Please briefly describe any comments, questions or special requests you have about the conference below.

First Name*
Last Name*
Company
Address*
City*
State*
Zip / Postal Code*
Home Phone*
Work Phone
E-mail*
Fax