Louisiana

EDUCATIONAL conference

June 7-10, 2023

Paragon Casino

Marksville, La.


Name:*
Address:*
Phone:
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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: 2023
INDIVIDUAL CONFERENCE REGISTRATION:(Late/Onsite)
MILITARY RATE For active military personnel. ID required at conference registration.
SQUAD CONFERENCE REGISTRATION
GROUP CONFERENCE REGISTRATION: (5+)
SQUAD CONFERENCE REGISTRATION(Late Registration)(After Juen 07, 2023)
GROUP CONFERENCE REGISTRATION: (5+) (Late Registration)

For additional members (more than 4) please supply a separate spread sheet with this data.
Single Day Registration (per day)(Wednesday)
Single Day Registration (per day)(Thursday)
Single Day Registration (per day)(Friday)
Single Day Registration (per day)(Saturday)
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)
?(2)(1)

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

Paragon Casino

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                                                    and asking for the group rate “LANREMT”.

Paragon Casino 


Hotel Group Reservation Deadline is May 16, 2019