Annual Meeting 2022 Summit to Sound Join WA-ACEP May 25-27 for our in-person Summit to Sound! May 25-277 Bell Harbor Conference Center Seattle, WA 2022 Summit to Sound Registration HiddenDate MM slash DD slash YYYY Contact InformationName* First Last Credentials* Preferred First Name for Badge (If Different than Above) ED Group/Hospital* Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands PhoneEmail* 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.Please indicate how you plan to attend the conference:* Full Conference Registration One-Day Registration Workshops Only - May 25 If only attending one day, please indicate which date: May 26, 2022 May 27, 2022 FULL CONFERENCE REGISTRATION*Please select the appropriate registration rate below. Member Physician - $350.00 Non-Member Physician - $460.00 Allied Health Professional - $225.00 EMT/Paramedic - $225.00 Retired - $155.00 Resident/Student - $55.00 FULL CONFERENCE REGISTRATION*Please select the appropriate registration rate below. Member Physician - $375.00 Non-Member Physician - $475.00 Allied Health Professional - $255.00 EMT/Paramedic - $255.00 Retired - $125.00 Resident/Student - $55.00 - $55.00 ONE-DAY REGISTRATION*Please select the appropriate registration rate below. Member Physician - $175.00 Non-Member Physician - $275.00 Allied Health Professional - $110.00 EMT/Paramedic - $110.00 Retired - $50.00 Resident/Student - $25.00 ONE-DAY REGISTRATION*Please select the appropriate registration rate below. Member Physician - $205.00 Non-Member Physician - $305.00 Allied Health Professional - $140.00 EMT/Paramedic - $140.00 Retired - $80.00 Resident/Student - $55.00 PRE-CONFERENCE Advanced Emergency Ultrasound + High Risk and Rare Procedure Lab Workshops – May 25, 2022HiddenUndifferentiated Shock, Emergency Ocular US, and Peripheral Nerve Blocks 9:00 - 11:30 AM - $125.00 9:00 - 11:30 AM - Resident Pricing - $20.00 Undifferentiated Shock, Emergency Ocular US, and Peripheral Nerve Blocks 9:00 - 11:30 AM - $150.00 9:00 - 11:30 AM Resident - $20.00 9:00 - 11:30 AM Student - $0.00 HiddenCricothyroidotomy, Lateral Canthotomy and Transvenous Pacing 1:00 - 3:30 PM - $125.00 1:00 - 3:30 PM - Resident Pricing - $20.00 Advanced Emergency Ultrasound + High Risk and Rare Procedure Lab: Cricothyroidotomy, Lateral Canthotomy and Transvenous Pacing 1:00 - 3:30 PM - $150.00 1:00 - 3:30 PM Resident Resident - $20.00 1:00 - 3:30 PM Student - $0.00 COVID Screening Requirements WA-ACEP supports and aligns with Public Health guidelines on COVID safety precautions, and will require attendees to comply with standard recommendations set by the WA-DOH and/or CDC at the time of the conference.* I will follow WA-DOH and CDC COVID safety guidelines, including mask wearing, social distancing, and showing proof of vaccination should that be recommended at the time of the conference. Optional Add-Ons Friday afternoon Argosy Cruise 1:00 - 4:00 PM I will participate in the Friday afternoon social activity (free)! TOTAL $0.00 CREDIT CARD American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Expiration Date Month010203040506070809101112 Year20222023202420252026202720282029203020312032203320342035203620372038203920402041 Security Code Cardholder Name CANCELLATION 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 May 1, 2022. INQUIRES: Contact the WA/ACEP Office at 206-956-3648 or send emails to admin@washingtonacep.org. Registration Information One 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. Δ