Medic Update Attendee Registration Form

Attendee Information

FirstName:    

Last Name:

Home Address:

City:      State:         Zip:

Contact Phone Number:     

E-Mail Address: 

Level of Licensure: First ResponderEMT-BasicEMT-IntermediateEMT-ParamedicCritical Care ParamedicRegistered Nurse    

OEMTA Member #:

  Attendence Selection

  Please Select All That Apply:

 Main Conference Registration (Member:$165.00 Non Member: $190.00) Prices

after July 14, 2010 will change. (Member: 190.00 Non-Member: 215.00)

 Conference Day 1 (Select only if attending only Day 1 of the Conference) $75.00 Member $90.00 Non-Member

 Conference Day 2 (Select only if attending only Day 2 of the Conference) $75.00 Member $90.00 Non-Member

 Conference Day 3 (Select only if attending only Day 3 of the Conference) $75.00 Member $90.00 Non Member

Wednesday Pre-Conference - Haz Mat Awareness,

 Wednesday Pre-Conference - Member/Vendor Golf 

 Wednesday Pre-Conference - ICS  for  EMS to include Triage Exercise ($50.00 Member $65.00 Non member)

 Wednesday Pre-Conference - EMS Instructor Workshop ($50.00 Member $65.00 Non Member)

 Payment Method

Please Select your Method of Payment

 Purchase Order :  PO Number:

Company Name:     Phone: 

City:     State:    Zip: 

Contact Person: 

E-Mail Address: 

Credit Card (if paying by credit card,  submit this form and Click on the link to our NEW ONLINE STORE  located at the left upper side of the screen to  SECURED website for Credit Card Information)

 Check or Money Order  (if paying by check or money order please print this form and mail to OEMTA, P.O. Box 416  El Reno, OK 73036 or fax to 866.265.8980) Please fill in all boxes to complete your order timely.

We now accept all Major Credit Cards including Debt and Federal Cards. 

 American Express is not accepted at this time.