minnesota ems medical directors association

Downloads

Complete your vendor support and registration completely online!

Organization

Organization Name*
Street Address Line 1:*
Street Address Line 2:
City*	State/Province*	Zip Code*






* Required

Attendees


How many people are you registering to staff your booth?*
Primary Contact
First Name*	Last Name*	Telephone Number*

EMail Address*
Second Attendee
First Name*	Last Name*	Telephone Number*

EMail Address*
Third Attendee
First Name*	Last Name*	Telephone Number*

EMail Address*
Fourth Attendee
First Name*	Last Name*	Telephone Number*

EMail Address*
Fifth Attendee
First Name*	Last Name*	Telephone Number*

EMail Address*
What level of support are you providing?* Major Support - $2,000 Platinum Support - $1,500 Gold Support - $1,100 Silver Support - $750 Non Profit Organization: Must be pre-approved to qualify - $350
Comments:






* Required

Payment

Method of Payment:
**If you are mailing a check, make the check payable to MN EMS Medical Directors and mail it to us at the address on the right.
**By checking the credit card box you authorize us to bill your credit card and agree to make payments according to your agreement with card issuer.

Credit Card. By checking this box you authorize us to charge your credit card and agree to pay the charge according to the agreement with the card issuer.

Confirmations/Cancellations Policies:

Please register for the conference as EARLY as possible.

Registrations will be confirmed via e-mail. Registrations received after August 25th WILL NOT be confirmed in writing.

If canceled, the registration fee, minus a $50.00 processing charge, is refundable if notice of cancellation is received by August 22nd.

No refunds will be made after August 22nd.

I Acknowledge Receipt of the conference Confirmations and Cancellations Policies*

Yes

* Required

Minnesota EMS Medical Directors Association
c/o Robin Hoppenrath

P.O. Box 1012
Anoka, Minnesota 55304

763.222.6005