Individual Convention Registration

Required fields are labeled in red. A squad affiliation is requested if attending the dinner.

First Name:
Last Name:
Contact Phone #:
Contact E-mail:
Rescue/EMS Squad Affiliation:
Number of Guests:
Total Number for Dinner:

OEMS Workshop Attendance

We are offering an NCOEMS Program Director workshop (one day, 8 hours) for $125 which includes convention registration in addition to a half day class on Friday for Instructors. Please specify convention attendees and the number partaking in dinner, above, in addition to how many will be attending each class, below. Each person may register for/attend no more than one of the following classes. When paying on-line, please include the number of people attending the convention and also people attending each class.

I want to attend the Program Directors Workshop on Thursday, Sept 11
I want to attend the Instructors Workshop on Friday, Sept 12

Order #:^* [Place Order] <-- opens a new window to pay on-line^*

Guest Names

Guest Name (1):

Guest Name (2):

Guest Name (3):

Guest Name (4):

Guest Name (5):

Guest Name (6):

Guest Name (7):

Guest Name (8):

Guest Name (9):

Guest Name(10):

Guest Name(11):

Guest Name(12):

Guest Name(13):

Guest Name(14):

Guest Name(15):

Guest Name(16):

Guest Name(17):

Guest Name(18):

Guest Name(19):

Guest Name(20):

^* Use the place order link to pre-pay on-line with a credit card. You'll need to enter the number of people in your party including those attending the NCOEMS workshop(s) in the Convention Registration item, add it to your cart and check out (choose CC option). Once you have an order #, put it in the order number field on this form for reference.

N.C. Association of Rescue & E.M.S., Inc.

Serving the Rescue and Emergency Medical Personnel in North Carolina

Individual Convention Registration