>[ over ]

> Register before October18th

& receive aN IEMSA T-Shirt

SIZE: m S m M m L m XL m XXL m XXXL

IEMSA Individual Membership: Save up to $90[SIGN-UP OR RENEW NOW & PAY MEMBER PRICES TODAY!]

$ ___________ m New m renew : $30/YR

Thursday : Pre-Conference WORKSHOP REGISTRATION:

$ ___________ SELECT ONE WORKSHOP: m CCP REFRESHER m HAZMAT WORKSHOP $120 MEMBER / $140 NONMEMBER

$ ___________ Medical Director 1/2 DAY WORKSHOP $60 MEMBER / $70 NON-MEMBER

$ ___________ service Director 1/2 DAY workshop $60 MEMBER / $70 NON-MEMBER

$ ___________ AMLS 2-day (THURS & FRI) workshop* $200/PP *MUST MEET MINIMUM OF 12 ATTENDEES

2-Day : FRIDAY & SATURDAY Conference REGISTRATION:

$ ___________ WITH LUNCH $250 MEMBER / $320 NON-MEMBER

$ ___________ WITHOUT LUNCH $220 MEMBER / $290 NON-MEMBER

1-DAY : Friday REGISTRATION

$ ___________ WITH LUNCH $180 MEMBER / $255 NON-MEMBER

$ ___________ WITHOUT LUNCH $165 MEMBER / $240 NON-MEMBER

1-DAY SATURDAY REGISTRATION:

$ ___________ WITH LUNCH $180 MEMBER / $255 NON-MEMBER

$ ___________ WITHOUT LUNCH $165 MEMBER / $240 NON-MEMBER

$ ___________ Additional Lunch Tickets : $20/EACH

$ ___________ TOTAL REGISTRATION FEES

FIRST NAME LAST NAME:

ADDRESS

CITY/STATE/ZIP

SSN OR DL# DATE OF BIRTH:

PHONE EMAIL

21

> ONLINE by credit card: Go to www.iemsa.net/conference—click on “Register Now”,complete the online form, make payment securely by credit card.

> Complete this registration form & mail with Payment to confirm your registration. Make checks payable to IEMSA and mail to: 5550 Wild Rose Lane, Ste. 400, West Des Moines, IA 50266.

> Complete this form and FAX This method is only for credit card payment registrations. Fax to 877-478-0926.

REFUND POLICY: Refunds, less a $50 processing fee, will be made for cancellations made prior to October 18th. No refunds made after Oct 16th.

registration DEADLINE: Register prior to October 30th to ensure entrance to the conference. Registrations received after this date & on-site registrations may be limited. IEMSA will not invoice services for payment. PO’s not accepted form of payment.

CANCELLATION POLICY: The Conference committee reserves the right to cancel any session or special event that does not meet minimum requirements, or to change a speaker as necessary.

REGISTRATION FORM -----> CONTINUED ON PAGE 22[ [

registration2013 : 24th Annual IEMSA Conference registration

3-ways to REGISTER:>

REGISTRANTS MUST PROVIDE CERTIFICATION INFORMATION TO RECIEVE CONTINUING EDUCATION CERTIFICATE:

CERTIFICATION LEVEL CERT/LICENSE # EXP DATE:

REGISTRANT’S FIRST NAME REGISTRANT’S LAST NAME:

22

>

[ t h a n k y o u ]

registrationPLEASE CHECK THE CLASSES YOU WILL BE ATTENDING:

> DAY 1 : FRIDAY, NOVEMBER 8TH, 2013

0 7 : 4 5 - 0 9 : 0 0 m General session : Life Worth Saving, It Must Be Worth Living-STEVE BERRY

0 9 : 4 5 - 1 0 : 3 5 m Track A A-General : Hazmat:”Chemist or the Non-Chemist”-ART SAENZ

m Track B-Basic : Surviving Columbine—WILKINS & JOHNSON

m TRack C-Advanced : Coverdell Stroke Project— REBECCA SWIFT & BRIAN HELLAND

1 0 : 4 5 - 1 1 : 5 5 m Track A-General : What is Going On in There—KEVIN-MCFARLANE

m Track B-Basic : Death on Scene-ME—STEVE BERRY

m Track C-Advanced : Don’t Get Burned!—LARRY MACY

1 3 : 0 0 - 1 3 : 5 5 m Track A-General : Teen Suicide—KEVIN MCFARLANE

m Track B-Basic : Mama, Don’t Let Your Kids Grow Up To Be Ambulance Drivers —STEVE BERRY

m Track c-Advanced : New Untouchables—CHRIS SUPRUN

1 4 : 0 5 - 1 4 : 5 5 m Track A-General : Sorry I Don’t Speak Peds!—KEVIN MCFARLANE

m Track B-Basic : Tales From the Dark Side—CHRIS SUPRUN

m Track C-Advanced : Spiders,Scorpions, & Snakes-OH MY!—LARRY MACY

1 5 : 4 0 - 1 6 : 5 5 m General session : The Lies Hollywood Told Me!—KEVIN MCFARLANE

> DAY 2 : SATURDAY, NOVEMBER 9TH, 2013

0 8 : 2 5 - 0 9 : 1 5 m General SESSION : Thru the Eyes of the Rescuer—JASON DUSH

0 9 : 4 5 - 1 0 : 3 5 m Track A-General : ECG’s Made Easy—LARRY MACY

m Track B-Basic : Young Guns-School Shootings—CHRIS SUPRUN

m Track C-Advanced : Sentimental Journey-A Final Wish Come True —STEVE BERRY

1 0 : 4 5 - 1 2 : 0 0 m Track A-General : Man VS Machine—JASON DUSH

m Track B-Basic : How Did I End Up in Hee Haw? Rural EMS—CHRIS SUPRUN

m Track C-Advanced : 2 Dudes & 2 Beers;Alcohol & Minor Trauma —KEVIN MCFARLANE

1 3 : 0 0 - 1 4 : 1 5 m Track A-General : Bath Salts—JASON DUSH

m Track B-Basic : Child Birth & Complicated Deliveries—TERRY RAGALLER

m Track C-Advanced : Home Improvement Trauma—STEVE BERRY

1 4 : 2 5 - 1 5 : 1 5 m Track A-General : EMS System Standards Success Stories —BY SYSTEM STANDARDS COMMITTEE MEMBERS

m Track B-Basic : HOLE Story-Implications of Body Piercing—STEVE BERRY

m Track C-Advanced : How to Expect the Unexpected—JASON DUSH

1 5 : 2 5 - 1 6 : 4 0 m General SESSION : Who put the A** in Assessment?—CHRIS SUPRUN

2013 : 24th Annual IEMSA Conference registration

CREDIT CARD Payment:

Credit Card Number

Expiration date security code

Card holder name

address

city/state/zip

Authorized Signature

> ONLINE by credit card: Go to www.iemsa.net/conference—click on “Register Now”,complete the online form, make payment securely by credit card.

> Complete this registration form & mail with Payment to confirm your registration. Make checks payable to IEMSA and mail to: 5550 Wild Rose Lane, Ste. 400, West Des Moines, IA 50266.

> Complete this form and FAX This method is only for credit card payment registrations. Fax to : 877-478-0926.

REFUND POLICY: Refunds, less a $50 processing fee, will be made for cancellations made prior to October 18th. No refunds made after Oct 16th.

registration DEADLINE: Register prior to October 30th to ensure entrance to the conference. Registrations received after this date & on-site registrations may be limited. IEMSA will not invoice services for payment. PO’s not accepted form of payment.

CANCELLATION POLICY: The Conference committee reserves the right to cancel any session or special event that does not meet minimum requirements, or to change a speaker.

3-ways to REGISTER:

continued—

R e g i s t e r b y O c t o b e r 1 8 t h to receive a free IEMSA T-Shirt.

19

>

Thursday : Special Events1 9 : 0 0 - 2 3 : 0 0 — “The gathering Place”

400 WALNUT ST, DES MOINES

DRINK SPECIALS, LIGHT SNACKS, AND A JOLLY GOOD TIME!

1 7 : 0 0 - 1 9 : 0 0 — EXHIBIT HALL WELCOMING RECEPTION BEAT THE RUSH - VISIT THE EXHIBITORS DURING THIS RECEPTION. VENDORS ARE FEATURING “THE TOOLS OF YOUR TRADE”—NEW PRODUCTS, SERVICES THAT YOU

USE AND NEED. DRINKS AND SNACKS PROVIDED.

friday : Special Events:

0 9 : 0 0 - 1 7 : 4 0

EXHIBIT HALL HOURS

2 0 : 3 0 - 2 3 : 3 0

friday night entertainment

BACK BY POPULAR DEMAND

The Johnny Holm Band

C o m m u n i t y C h o i c e C r e d i t u n i o n B a l l r o o m • BALLROOM • NEW! PHOTO BOOTH & GAMES •

Saturday : Special Events

(must be present to win)

DROP OFF YOUR

“GIVE-AWAY ENTRY CARD” AT THE IEMSA BOOTH

LOCATED IN THE VENDOR HALL!

WINNERS ANNOUNCED IN THE VENDOR HALL DURING THE

SATURDAY MORNING BREAK 0 9 : 1 5 - 0 9 : 4 5

AND SATURDAY LUNCH BREAK

1 2 : 0 0 - 1 3 : 0 0

VENDOR Give-Away

Sponsored by

Schedule-At-A-Glance2013 : 24th Annual IEMSA Conference

: REGISTRATION SIGN-IN : 0 7 : 0 0 - 1 7 : 0 0

: REGISTRATION SIGN-IN : 0 7 : 0 0 - 1 2 : 0 0DAY 2 : SATURDAY, NOVEMBER 9TH, 2013 0 8 : 2 5 - 0 9 : 1 5 General SESSION : Thru the Eyes of the Rescuer—JASON DUSH

0 9 : 4 5 - 1 0 : 3 5 Track A-General : ECG’s Made Easy—LARRY MACY

Track B-Basic : Young Guns-School Shootings—CHRIS SUPRUN

Track C-Advanced : Sentimental Journey-A Final Wish Come True—STEVE BERRY

1 0 : 4 5 - 1 2 : 0 0 Track A-General : Man VS Machine—JASON DUSH

Track B-Basic : How Did I End Up in Hee Haw? Rural EMS—CHRIS SUPRUN

Track C-Advanced : 2 Dudes & 2 Beers;Alcohol & Minor Trauma—KEVIN MCFARLANE

1 3 : 0 0 - 1 4 : 1 5 Track A-General : Bath Salts—JASON DUSH

Track B-Basic : Child Birth & Complicated Deliveries—TERRY RAGALLER

Track C-Advanced : Home Improvement Trauma—STEVE BERRY

1 4 : 2 5 - 1 5 : 1 5 Track A-General : EMS System Standards Success Stories —BY SYSTEM STANDARDS COMMITTEE MEMBERS

Track B-Basic : HOLE Story-Implications of Body Piercing—STEVE BERRY

Track C-Advanced : How to Expect the Unexpected—JASON DUSH

1 5 : 2 5 - 1 6 : 4 0 General SESSION : Who put the A** in Assessment?—CHRIS SUPRUN

PRE-CONFERENCE WORKSHOPS : THURSDAY, NOVEMBER 7TH, 2013 0 8 : 0 0 - 1 6 : 3 0 CCP Refresher Workshop : What’s New in Airway? —LEE RIDGE; Ventilation Management and the

Truth Re Oxygenation—ROSEMARY ADAM; Staffing: Medic vs. CCP Missions—MARK MCCULLOCH; Drip and Ship —ROSEMARY ADAM; Technology in Cardiovascular ICU —KIM LOPEZ

EMS HAZMAT: The Continuing Challenge —ART SAENZ

Medical Director/Service Director Workshop

NEW! AMLS : 2-Day Workshop *A MINIMUM OF 12 ATTENDEES IS NEEED TO HOLD THIS WORKSHOP

DAY 1 : FRIDAY, NOVEMBER 8TH, 2013 0 8 : 0 0 - 1 6 : 3 0 AMLS (2-Day Workshop)

0 7 : 4 5 - 0 9 : 0 0 General session : Life Worth Saving, It Must Be Worth Living -STEVE BERRY

0 9 : 4 5 - 1 0 : 3 5 Track A-General : Hazmat:”Chemist or the Non-Chemist”-ART SAENZ

Track B-Basic : Surviving Columbine—DR. ROSS WILKINS, MD & KACEY L. JOHNSON, RN

Track C-Advanced : Coverdell Stroke Project —REBECCA SWIFT BRIAN HELLAND

1 0 : 4 5 - 1 1 : 5 5 Track A-General : What is Going On in There—KEVIN-MCFARLANE

Track B-Basic : Death on Scene-ME—STEVE BERRY

Track C-Advanced : Don’t Get Burned!—LARRY MACY

1 3 : 0 0 - 1 3 : 5 5 Track A-General : Teen Suicide—KEVIN MCFARLANE

Track B-Basic : Mama, Don’t let your kids grow up to be Ambulance Drivers —STEVE BERRY

Track C-Advanced : New Untouchables—CHRIS SUPRUN

1 4 : 0 5 - 1 4 : 5 5 Track A-General : Sorry I Don’t Speak Peds!—KEVIN MCFARLANE

Track B-Basic : Tales From the Dark Side—CHRIS SUPRUN

Track C-Advanced : Spiders,Scorpians, & Snakes-OH MY!—LARRY MACY

1 5 : 4 0 - 1 6 : 5 5 General session : The Lies Hollywood Told Me!—KEVIN MCFARLANE

REGISTRATION SIGN-IN :

0 7 : 0 0 - 1 7 : 0 0

1 1 : 1 5 - 1 2 : 1 5 ANNUAL IEMSA BOARD MEETING