2017 Summit to Sound Registration Contact Information Name:*FirstLast Title: Preferred First Name for Badge: ED Group/Hospital: Address: Street Address Street Address Line 2 City State / Province / Region Postal / Zip Code Phone: Area Code - Phone Number E-mail:*E-mail address is required to receive a confirmation/receipt and your e-syllabus.Conference registration fee includes tuition, e-syllabus, welcome reception, as well as breakfasts, AM/PM breaks, and lunches. Please register separately for the Pre-Conference Workshops.Conference Registration 2017 Summit to Sound Registration Registration:Member Physician - $355Canadian Physician - $345Non-Member Physician - $455Allied Health Professional - $255Canadian Allied Health Professional - $245EMT/Paramedic - $255Retired - $155Resident/Student - $801-Day Only: Member Physician - $2051-Day Only: Non Member Physician - $3051-Day Only: Allied Health Professional - $1401-Day Only: EMT/Paramedic - $1401-Day Only: Retired - $801-Day Only: Resident/Student - $551-Day Only: Canadian Physician - $1951-Day Only: Canadian Allied Health Professional - $140Early Bird Member Physician - $325 1-Day Only Registration - Please indicate on which date you will be attending:Select valueApril 27April 28Pre-Conference Workshops – April 26, 2017 2017 Summit to Sound workshop(s) that you would like to attend:Ultrasound Nerve Block Workshop (1-3:30 pm) - $150Ultrasound Vascular Access workshop (9-11:30 am) - $150Cadaver Lab - $175 Workshop Waiting List:The Cadaver Lab (9:00-11:30 am) is full. Please add me to the waiting listThe Cadaver Lab (1:00-3:30 pm) is full. Please add me to the waiting listRegistration Total Total: Please verify:SubmitResetCANCELLATION POLICY: We must receive written notification of your cancellation. A $50 processing fee will be deducted from the registration refund. No refunds will be issued after March 24, 2017.INQUIRES: Contact the WA/ACEP Office at 206-956-3648 or send emails to firstname.lastname@example.org.Registration InformationOne registration form per person is required. Please type or print clearly. Your name badge will reflect the information you provide on the registration form. A registration confirmation will be emailed to you.