Registrant Demographic

Last Name *

First Name *

Address *

City *

State *

Zip *

Phone Number *

Email Address *

Name on Badge

Employer

Print your Employer on Name Badge

Yes

No

Chapter Affiliation:

Certification Number

Pre-Conference

Registration includes lunch

Tuesday June 4, 2024

AHA BLS Instructor Workshop (Tuesday All Day)

With a Paid Conference Registration-----Free

Preconference Registration Only---$50.00

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-----------------Limited to 24-----------------

SO, You Want To Be A Drone Pilot (Tuesday All Day)

With a Paid Conference Registration-----$ 0.00

Pre-Conference Registration Only---$50.00

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-----------------Limited to 24-----------------

Applied Suicide Intervention Skills Training (ASIST) - Day 1 (Tues/Wed All Day)

With a Paid Conference Registration-----$0.00

Preconference Registration Only----$50.00

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-----------------Limited to 50----------------

Pre-Hospital Trauma Life Support (Day 1) (Tues/Wed (All Day)

With a Paid Conference Registration-----$ 0.00

With Preconference Registration Only---$50.00

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-----------------Limited to 24-----------------

Medical Response Team Leader (Tues All Day)

With a Paid Conference Registration-----$ 0.00

Preconference Registration Only---$50.00

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-----------------Limited to 24-----------------

PreCon Tues June 4, 2024 Total

Wednesday June 5, 2024

Louisiana EMS Educator Workshop (Wednesday) (All Day)

With a Paid Conference Registration-----$ 0.00

With Preconference Registration Only---$50.00

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-----------------Limited to 24-----------------

HAM Operator Tech Licensure (Wednesday) (All Day)

With a Paid Conference Registration-----$ 0.00

Preconference Registration Only---$50.00

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-----------------Limited to 24----------------

Applied Suicide Intervention Skills Training (ASIST) - (Day 2) (Tues/Wed All Day)

With a Paid Conference Registration-----$ 0.00

Preconference Registration Only---$ 0.00

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-----------------Limited to 50-----------------

Pediatric Emergency Care Coordinator (Wednesday) (All Day)

With a Paid Conference Registration-----$ 0.00

Preconference Registration Only---$50.00

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-----------------Limited to 24---------------

Pre-Hospital Trauma Life Support (Day 2) (Tues/Wed All Day)

With a Paid Conference Registration-----$ 0.00

Preconference Registration Only---$0.00

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-----------------Limited to 24-----------------

PreCon Wednesday June 5, 2024 Total

Core Conference

Thursday June 6, 2024 to Saturday June 8, 2024

Individual Conference Registration

Before May 1---$150.00

After April 30---$175.00

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Includes educational sessions, banquet dinners, and Social Events

EMS Award Banquet (only) ---$30.00

Spouse/Partner/Guest Meal Saturday, June 8, 2024

Group Registration

Group Registration (1-5)-----$500.00

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Five (5) registrations paid in one payment.

Includes education sessions, lunches and banquet dinner for each registrant More than 5 add $100.00 each

Please complete page two of this form

Additional Group Conference Registration (6 or more)

For additional members please supply a separate spreadsheet with this data.

MILITARY RATE

Before May 1---$125.00

After April 30---$150.00

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For active military personnel. ID is required at conference registration.

ONE DAY REGISTRATIONS

Friday June 9,2023----------$100.00

Saturday June 10, 2023-----$100.00

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Core Conference Fees Thurs 6/6/24 to Sat 6/8/24 Total

On-site Conference registration will be $200.00

Additional Squad Registration 2-5

Squad Member #2

Last Name #2

First Name #2

Address #2

City #2

State #2

Zip #2

Phone Number #2

Email Address #2

Name on Badge 2

Employer #2

Print your Employer on Name Badge #2

Yes

No

Chapter Affiliation: #2

Certification Number 2

Pre-Conference Attendance 2 (If attending)

Pre-Conference Tuesday June 4, 2024 2

Pre-Conference Wednesday June 5, 2024 2

Squad Member #3

Last Name #3

First Name #3

Address #3

City #3

State #3

Zip #3

Phone Number #3

Email Address #3

Name on Badge 3

Employer #3

Print your Employer on Name Badge #3

Yes

No

Chapter Affiliation: #3

Certification Number #3

Pre-Conference Attendance 3 (If attending)

Pre-Conference Tuesday June 4, 2024 3

Pre-Conference Wednesday June 5, 2024 3

Squad Member #4

Last Name #4

First Name #4

Address #4

City #4

State #4

Zip #4

Phone Number #4

Email Address #4

Name on Badge 4

Employer #4

Print your Employer on Name Badge #4

Yes

No

Chapter Affiliation: #4

Certification Number 4

Pre-Conference Attendance 4

Pre-Conference Tuesday June 4, 2024 4

Pre-Conference Wednesday June 5, 2024 4

Squad Member #5

Last Name #5

First Name #5

Address #5

City #5

State #5

Zip #5

Phone Number #5

Email Address #5

Name on Badge 5

Employer #5

Print your Employer on Name Badge #5

Yes

No

Chapter Affiliation: #5

Certification Number 5

Pre-Conference Attendance 5

Pre-Conference Tuesday June 4, 2024 5

Pre-Conference Wednesday June 5, 2024 5

Payment

PreCon Wednesday Sub Total

PreCon Thursday Sub Total

Core Conference Fees Sub Total

Conference Total

Payment Methods *

Paragon Resort and Conference Center
Marksville, LA 71351
318-253-1946
800-946-1946
Mention the LANREMT Conference for special room rates starting at $109.00.
Please refer to the Conference Code of LAJ04GR
Hotel Conference Rate

Louisiana Association of Nationally Registered Emergency Medical Technicians
Conference and Expo
Tuesday - JUNE 4, 2024 to Saturday - JUNE 8, 2024

Registrant Demographic

Pre-Conference

Registration includes lunch

Tuesday June 4, 2024

Wednesday June 5, 2024

Core Conference

Thursday June 6, 2024 to Saturday June 8, 2024

On-site Conference registration will be $200.00

Additional Squad Registration 2-5

Squad Member #2

Pre-Conference Attendance 2 (If attending)

Squad Member #3

Pre-Conference Attendance 3 (If attending)

Squad Member #4

Pre-Conference Attendance 4

Squad Member #5

Pre-Conference Attendance 5

Payment

Paragon Resort and Conference Center
Marksville, LA 71351
318-253-1946
800-946-1946
Mention the LANREMT Conference for special room rates starting at $109.00.
Please refer to the Conference Code of LAJ04GR
Hotel Conference Rate

Cutoff date May 23, 2024

Louisiana Association of Nationally Registered Emergency Medical TechniciansConference and ExpoTuesday - JUNE 4, 2024 to Saturday - JUNE 8, 2024

Registrant Demographic

Pre-Conference

Registration includes lunch

Tuesday June 4, 2024

Wednesday June 5, 2024

Core Conference

Thursday June 6, 2024 to Saturday June 8, 2024

On-site Conference registration will be $200.00

Additional Squad Registration 2-5

Squad Member #2

Pre-Conference Attendance 2 (If attending)

Squad Member #3

Pre-Conference Attendance 3 (If attending)

Squad Member #4

Pre-Conference Attendance 4

Squad Member #5

Pre-Conference Attendance 5

Payment

Paragon Resort and Conference CenterMarksville, LA 71351318-253-1946800-946-1946Mention the LANREMT Conference for special room rates starting at $109.00.Please refer to the Conference Code of LAJ04GRHotel Conference Rate

Cutoff date May 23, 2024

Louisiana Association of Nationally Registered Emergency Medical Technicians
Conference and Expo
Tuesday - JUNE 4, 2024 to Saturday - JUNE 8, 2024

Paragon Resort and Conference Center
Marksville, LA 71351
318-253-1946
800-946-1946
Mention the LANREMT Conference for special room rates starting at $109.00.
Please refer to the Conference Code of LAJ04GR
Hotel Conference Rate