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Accommodations
Board
Advisory Group
Conference Registration
Vendor Support

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Site
Web

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Solicitation
Support Prospectus
Support Level Definitions

Minnesota EMS Medical Directors Association
c/o Robin Hoppenrath, Executive Director

HPS Executive Group, LLC
P.O. Box 1012
Anoka, Minnesota 55304
763.222.6005

Our Partners:

MN Ambulance Association

MN EMS Honor Guard

MN EMS Regulatory Board

Complete your vendor support and registration completely online!
Organization Name

Address

Street Address
Street Address 2
City	State / Province
Postal / ZipCode	Country

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
You can register up to 5 people to staff your booth.
Primary Contact/First Attendee
Name

First Name
Last Name
Phone
Area CodePhone Number
Email

Address - if different than the organization's address

Street Address
Street Address 2
City	State / Province
Postal / ZipCode	Country

Are you registering a second person?
No
Yes

Second Attendee
Fullname

First Name
Last Name
Phone
Area CodePhone Number
Email

Address - if different than the organization's address

Street Address
Street Address 2
City	State / Province
Postal / ZipCode	Country

Are you registering a third person?
No
Yes

Third Attendee
Fullname

First Name
Last Name
Phone
Area CodePhone Number
Email

Address - if different than the organization's address

Street Address
Street Address 2
City	State / Province
Postal / ZipCode	Country

Are you registering a fourth person?
No
Yes

Fourth Attendee
Fullname

First Name
Last Name
Phone
Area CodePhone Number
Email

Address - if different than the organization's address

Street Address
Street Address 2
City	State / Province
Postal / ZipCode	Country

Are you registering a fifth person?
No
Yes

Fifth Attendee
Fullname

First Name
Last Name
Phone
Area CodePhone Number
Email

Address - if different than the organization's address

Street Address
Street Address 2
City	State / Province
Postal / ZipCode	Country

Method of Payment
Mailing us a check
*****If you are mailing a check, make the check payable to:

MN EMS Medical Directors Ass'n

and mail it to us at:

HPS Executive Group

PO Box 1012

Anoka, MN 55303

.
Credit Card
By checking this box you authorize us to bill your credit card and agree to make payments according to your agreement with 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.
Acknowledgement
I Acknowledge Receipt of the conference Confirmations and Cancellations Policies
When you click submit, you will be taken to our payment page. If you are mailing a check, simply close your browser AFTER you get to the payment page (do NOT close your browser before clicking on submit).

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