Event Registration

* Full Name:	(First & Last Name Required)
Level of Licensure:	Please Choose First Responder EMT EMT-IV Paramedic RN PA MD Other
Choose One:	Please Choose Program Director Paramedic Instructor/Coordinator Paramedic Instructor Assistant EMT Instructor/Coordinator EMT Instructor Assistant First Reponder Instructor EMT or Paramedic Student Service Training Coordinator EMS Provider Other
* Mailing Address:
* City:
* State:	AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY
* Zip Code:
Phone:
* E-mail:

Before July 10, 2008 - $150 Instructor/Provider and $65 Student After July 10, 2008/Onsite - $300 Instructor/Provider and $130 Student *Please Select (REQUIRED)
$150 Instructor/Provider $65 Student (Student ID will be confirmed)

Session Choice REMEMBER all Program Directors, and EMT and Paramedic Instructor Coordinators must attend one of the Masimo sessions. Seats are limited in sessions. Session preferences will be assigned on a first come first serve basis of registrations received.
First Session Choice:	Please Choose 1A 1B 1C 2A 2B 2C 3A 3B 3C 4A 4B 4C
Second Session Choice:	Please Choose 1A 1B 1C 2A 2B 2C 3A 3B 3C 4A 4B 4C
Third Session Choice:	Please Choose 1A 1B 1C 2A 2B 2C 3A 3B 3C 4A 4B 4C

TEMSEA Membership Dues $25 New or Renewal of Membership: Dues includes the cost of attending the banquet. RESERVATIONS REQUIRED * Please Select
I do not want to join at this time Regular Membership (Educators) Associate Membership (Providers/Students)

TEMSEA Banquet RESERVATIONS REQUIRED please indicate below your intent to attend the Banquet. Remember new or renewal membership dues include the Banquet but your must make a reservation. * Please Select (REQUIRED)
I plan to attend I will not be attending I will be bringing a guest and have included additional $35.00 for each (Tickets may be bought on site for guest will be $48.50 each upon availability) I would like to attend but I am not a member and have included $48.50