Registration Form

Additional Info

EMS On The Hill Day Welcome Guide

2017 EMS 3.0 Transformation Summit





 

REGISTRATION FORM

Please complete this form to register for one or both of the following events: 
 
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.


The Headquarters Hotel for both events is the Holiday Inn Rosslyn at Key Bridge. The room rate is $199 + tax for a single or double room, Group Code: EM7. This special rate is for reservations made by March 22, 2017.

EMS On The Hill Day Registrants: Your HOME ADDRESS is required on the registration form so we can identify your members of Congress and schedule your meetings accurately. Please include your CELL NUMBER in case we need to reach during the event.

 
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