National Association of State EMS Officials s1

National Association of State EMS Officials Mid-Year Meeting May 25-26, 2010 ● Doubletree Hotel, Bethesda, MD General Registration Form Program: Who should attend: Members of NASEMSO and federal officials with a role in Posted at www.nasemso.org. emergency medical services. The NASEMSO Mid-Year Meeting purpose is to address emergency medical services and homeland security legislative and regulatory issues, EMS Registration Fee: Education Agenda Implementation, EMS Communications, Intelligent Transportation, Air $240 includes Councils, Medical issues, EMSC, and more. Committees, and NASEMSO For more information: 703-538-1799 www.nasemso.org Program Name: ($125 to attend the Pediatric Emergency Care Council meeting) Select your Nickname for Badge:

registration: Title: Program Includes: Payment enclosed Handouts, breaks, and lunch. Please invoice me Organization:

Hotel Accommodations Address: & Meeting Location: $ Amount enclosed (or to be City/St/Zip: invoiced) Doubletree Hotel Phone: Fax: 8120 Wisconsin Ave. IMPORTANT: Email: Bethesda, MD 20814 Please indicate which Council Meeting(s) you To book accommodations: will be attending: (payable to – U.S. funds only)  1-800-222-TREE or Data Managers Payment Check NASEMSO 301-652-2000 Training Coord. Method: Purchase order  Reference NASEMSO Mid- Pediatric Emer. Care Visa MasterCard Year Meeting to secure the American Express $226 room rate  Room rate for NASEMSO For hotel location, nights (May 24 and 25) will maps, and other Name on card: transportation be honored until Friday, Card number: April 30, 2010 or until the information, click here. NASEMSO room block is Exp. Date: Signature: sold out. (May 26th is Approx cab fare from: included on the room block DCA - $50 Please check here to authorize if completing form electronically. for EMSC.) BWI- $72 Security Code (Located on Front or Back of Card): IAD- $55 30-45 minutes from all three Including 15% gratuity Credit Card Billing Address: Washington, DC airports: Ronald Reagan Washington National Cancellations received 14 days prior to the event will be granted a 50% Airport (DCA-11.5 mi), Dulles refund. No refund or credit will be granted for requests received less than 14 International Airport (IAD-27 mi), calendar days prior to the event. If you do not cancel your registration in and Baltimore-Washington writing and do not attend, full fees are due; you may however, send a International Airport (BWI-34.5 mi). substitute in your place. Participation in NASEMSO events and all Complimentary shuttle service is associated activities is at individual’s own risk. available from the Red Line, Fax, mail, or email this form to: Bethesda Metro and Medical Center NASEMSO ● 201 Park Washington Ct. ● Falls Church, VA 22046 Metro Stations. (Complete Fax: 703-241-5603 ● Phone: 703-538-1799 information and schedule are available from the hotel.) [email protected]