Registration Form

Additional Info

EMS On The Hill Day Welcome Guide




 

REGISTRATION FORM

Please complete this form to register for one or both of the following events in Washington, DC: 
 
EMS On The Hill Day -
April 25 (briefing on April 24). Registration will be open until April 10, 2017, and is non-refundable after that date. 
 
EMS 3.0 Transformation Summit
April 24, 2017. Registration is non-refundable after April 10, 2017.

Please note: When completing your registration, you must use your HOME ADDRESS, as this is the address required to identify your members of Congress with whom we will schedule your meetings for EMS On The Hill Day Day. Your phone number should be your CELL NUMBER at which you can be reached while in Washington, D.C. 

Headquarters Hotel is the Holiday Inn Rosslyn at Key Bridge, 1900 North Fort Myer Drive, Arlington, VA 22209. The room rate is $199 + tax for a single or double room. Reservations must be made by March 22, 2017 to receive this special rate. Rooms are subject to availability, so please book early! Reservations for this event can be made ONLINE or by calling 703-807-2000 or 800-368-3408 to speak with our in house Reservations Manager. The block code for the group is EM7.

 
PERSONAL INFORMATION
 
First Name *
Last Name *
Middle Initial
 
  Home Address
Street *
City *
State*
Zip*
 
Cell Number*
E-mail Address*
 
PROFESSIONAL INFORMATION
 
EMS Agency or Organization*  If not applicable, enter N/A    
Title
Medical Position*
   
REGISTRATION
EMS On The Hill Day
(Registration is $20 and open until April 10, 2017)
Click to register
EMS 3.0 Transformation Summit
(Registration is $75 / $85 after April 10, 2017)
Click to register