Online Registration Form

optional fields are marked with a red asterix (*)

EMSCC Membership

Are you an EMSCC Member? (Choose one)

Yes

General Information

Name:
Job Title:
Organization:
Address:
City:
Province / State:
Postal / Zip Code:
Email Address:
Work Phone:
Fax:
*Special Requirements:	(e.g. dietary, access, alternate media formats, etc. - please specify)

Guest Information

Are Your Bringing A Guest? (Choose one)

Yes

*If yes, please include the name of your guest

Delegate Contact List

The conference coordinators are preparing a list of delegates attending the EMSCC 2008 Conference. This contact list will be available to each delegate, speaker and sponsor. Contact information will include name, title, organization, phone number and email address. The personal information on this form will be used for the purpose of managing the conference only. Information is protected by the provisions of the Personal Information Protection and Electronic Documents Act.

May we include your name and contact information on this list? (Choose one)

Yes

Workshop Selection

There are several concurrent sessions offered on Friday, May 30. Please indicate which workshops you plan on attending:

1:00pm
	Session A1: Developing and Evaluating Front Line Supervisors Linked to KPI’s
	Session A2: EMS Master Planning

2:00pm
	Session B1: International Roundtable on Community Paramedicine
	Session B2: Infant Transport Team – Specialized Paramedicine in the Long Term

Conference Fees

All prices are quoted in Canadian Dollars.

Note: Conference Registration Fee includes all keynot speakers and concurrent sessions, welcome recrption, breakfasts, lunches and the social event on Thursday, May 29th, 2008.

Early Bird Registration (Before April 2, 2008)	Fee Amount
EMSCC Members	$400.00
Non-EMSCC Members	$500.00

Regular Registration (After April 2, 2008)	Fee Amount
EMSCC Members	$550.00
Non-EMSCC Members	$650.00
Additional Conference Banquet Ticket	$50.00

Registration Confirmation: Confirmation will be sent via email upon receipt of full payment.

Cancellation Policy: No cancellations will be accepted. Substitutions are welcome at no additional cost, but must be sent to the EMSCC Conference 2008 Committee by April 30, 2008. The EMSCC Conference 2008 Committee reserves the right to make adjustments to scheduling or the agenda.

Payment Method

Payment must accompany registration form.

Cheque / Money Order: Made payable to "EMSCC 2008" with the description: EMSCC Conference Registration. Payment must be made in Canadian dollars payable on a Canadian bank and free of all charges.

	Registration Fee ($)
	+ Additional Conference Banquet Ticket(s) ($)
	Total Fee Payable Fee Payable($)

Pay By Credit Card

Credit card transactions will be processed over the phone by the EMSCC Conference Committee. Should you wish to pay via credit card, please select the "Yes" button below. A member of the EMSCC Conference Committee will be in contact to collect your credit card information.

Would you like to pay using a credit card?

Yes

Should you have any questions please contact:

Suzanne Dane
Event Manager, EMSCC Conference
Phone: (250) 385-1157

Online Registration Form

Conference Fees

Payment Method

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