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2022 Texas EMS Conference
Registration Form

Full Conference:	November 20 - 23, 2022
Pre-Conference Classes:	November 18 - 20, 2022
Trade Show:	November 20 - 21, 2022
Location:	Austin Convention Center, Austin, Texas

Online registration will close at midnight on November 11, 2022.

TERMS & CONDITIONS

*By signing up for the conference, you agree to have your likeness reproduced in publications.

I agree to Texas EMS Conference Terms and Conditions.

COVID-19 LIABILITY WAIVER

I agree to Texas EMS Conference COVID-19 Liability Waiver.

CONTACT INFORMATION

Registration Number

*Required

INFORMATION USED FOR NAME BADGE – Please enter information exactly as you want to be identified.

TDH PAID

*First Name

*Last Name

*First Name Preferred on Name Badge

Company

*Address

*City

*State

*Country

*Zip Code

*Phone Number
in the format of xxx-xxx-xxxx

*Email

*Confirm Email

*Indicate Your Job Function

If 'Other', please specify:

*Type of Service

If 'Other', please specify:

*Do you make or influence the decisions on company purchases for products/services?

Yes

CONFERENCE REGISTRATION

Please select one of the registration options below:

Full Conference - $305 until July 31

Monday Only - $200

Tuesday Only - $200

GETAC Member

GETAC Committee Member - $200

DSHS

Complimentary

Student - $200

Pre-Conference Classes Only (See below)

If you have been provided a registration code, please enter it below:

*Valid student I.D. or other proof of enrollment required when you pick-up your badge at Texas EMS Conference.

If you have been provided a registration code, please enter it below:

*Student I.D. #

*EMS Program Institution

ADDITIONAL REGISTRANTS

If you would like to add an additional participant, please click on the 'Add another registrant' button below.

Add another registrant

PURCHASE ORDER NUMBER

If you are paying with a purchase order, please enter it into the text box below and select "PURCHASE ORDER NUMBER" in the "PAYMENT INFORMATION" section below.

PAYMENT OPTIONS

Summary

Total (USD):

CREDIT CARD MasterCard

You will be prompted to enter card details after submitting this registration.

ADMIN ONLY

Conference Use Only-Do Not Select. Your registration will not be processed if you select this option.

CHECK

Payment by check is accepted for registration. Check payment is due ten (10) days from date of registration. You will receive an invoice by email when you submit the registration. Mailed payments must be postmarked by deadline to receive discount rate.

PURCHASE ORDER NUMBER

Please select this option if you are registering with a Purchase Order. Payment is due thirty (30) days from date of registration. You will receive an invoice by email when you submit the registration. Mailed payments must be postmarked by deadline to receive discount rate.

NOTE: Please ensure that you have entered a Purchase Order number in the "Purchase Order Number" section above.

QUESTIONS?
If you have questions, please contact the Texas EMS Conference by phone at 512-759-1720 or by email at [email protected].

CANCELLATION/REFUND POLICY
No refunds after October 18, 2022. Up until October 18, 2022, refunds are subject to a 20% administrative fee. Mailed payments must be postmarked by deadline to receive early-bird discount. Online registration will close at midnight on November 11, 2022.

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