Louisiana

EDUCATIONAL conference

June 21-22, 2019

Pre-Conference

June 17-20, 2019


Name:*
Address:*
Phone:
-
E-mail:
Employer:
Chapter Affiliation:
Name on Badge:
Print Employer on badge:
National Registry #:

CORE CONFERENCE

Includes educational sessions,  lunches and banquet dinner


INDIVIDUAL CONFERENCE REGISTRATION: (Early Registration)
INDIVIDUAL CONFERENCE REGISTRATION:
INDIVIDUAL CONFERENCE REGISTRATION:(Late/Onsite)
STUDENT CONFERENCE REGISTRATION: A student that is enrolled/finished a course but they have not yet been certified/licensed
Instructor Name:
Couse Number:
MILITARY RATE For active military personnel. ID required at conference registration.
SQUAD CONFERENCE REGISTRATION
GROUP CONFERENCE REGISTRATION: (5+)
SQUAD CONFERENCE REGISTRATION(Late Registration)
GROUP CONFERENCE REGISTRATION: (5+) (Late Registration)

For additional members (more than 4) please supply a separate spread sheet with this data.
Spouse/Partner/Guest Meal

Onsite Conference Fee---------------------------$200.00

Dues Payment is Included in the Conference Fee

Please choose a chapter

The default chapter will be At Large



Chapter Choice:
How did you find out about the conference?

Pre-Conference Registration



Ace 4 EMS Louisiana Initial Instructor Course Pre-Conference-----June 17/18/19 2019-----Class Limit 15-----Deadline 6/14/2019
(NAEMT's) Tactical Emergency Casualty Care (TECC)-----June 17 & 18, 2019-----Class Limit 30-----Deadline 6/14/2019
NAEMT PEPL Course Pre-Conference-----June 17& 18, 2019------Class Limit 15-----Deadline 6/14/2019
EMS Response to Active Shootings "The Rescue Task Force " Pre-Conference-----June 19, 2019-----Class Limit 30-----Deadline 6/14/2019
AHA Instructor Course Pre-Conference-----June 17 & 18, 2019-----Class Limit 12-----Deadline 6/14/2019
Moulage Concepts full day Course Pre-Conference-----June 20, 2019-----Class limit 30-----Deadline 6/19/2019
High School 911-Movie Viewing Pre-Conference-----June 20, 2019-----Class Limit unlimited-----Deadline 6/14/2019

Additional Registration

Please complete for each registrant


Conference Group Registrant #2

Name:(2)
Address:(2)
Phone:(2)
-
E-mail:(2)
Employer:(2)
Chapter Affiliation:(2)
Name on Badge:(2)
Print Employer on badge:(2)
National Registry #:(2)

Conference Group Registrant #3

Name:(3)
Address:(3)
Phone:(3)
-
E-mail:(3)
Employer:(3)
Chapter Affiliation:(3)
Name on Badge:(3)
Print Employer on badge:(3)
National Registry #:(3)

Conference Group Registrant #4

Name:(4)
Address:(4)
Phone:(4)
-
E-mail:(4)
Employer:(4)
Chapter Affiliation:(4)
Name on Badge:(4)
Print Employer on badge:(4)
National Registry #:(4)

Payment



Payment Method: Your rate will be locked in at the time of this registration*

To pay with PayPal

1. Press Submit Button to go to PayPal

2. Complete payment and you will be returned to web page.

If you do not have a PayPal account and want to pay with PayPal

1. Press Submit Button to go to PayPal

2. Set up an account and pay with PayPal.

If you do not have a PayPal account and wish not to pay with PayPal

1. Press Submit Button to go to PayPal

2. Close out the PayPal and send your payment to:

P.O. Box 86456

Baton Rouge, LA 70879-6456

Total:
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Conference Hotel

Red Roof Inn LSU Convention Center  Baton Rouge,  Louisiana

A block of rooms has been reserved and a special rate of $89.00 for EMS Conference attendees. The reservation deadline is May 16, 2019. Rooms are limited so early reservations are highly recommended. Make your reservations by calling the Red Roof Inn LSU Convention Center Baton Rouge  at 225-236-4000 and asking for group rate “LANREMT”.

Red Roof Inn LSU Convention Center Baton Rouge

2445 S Acadian Thruway

Phone 225-236-4000

FAX 225-929-6033

https://www.redroof.com/property/la/baton-rouge/RRI1155

Hotel Group Reservation Deadline is May 16, 2019

 2018 Conference Vendors

AASI Air Evac AMR
Brady Braun Built for Life Henry Schein
JBL Public Safety Group LERN Logo1 med trans logo
medexpress Physio Control RSI
stryker   zoll logo blue png