EMS Safety & System Design Summit Registration Name* First Last Title / Position* Mayor, City Manager, Township Supervisor, Clerk, EMS Chief, Physician, MCA Administrator, Etc.Organization Type*Local, State, National Government Representative (Not EMS or FD)Hospital or Health System RepresentativeEMS Oversight or Regulatory Agency (Local, state, national)EMS AgencyEMS Medical DirectorMunicipal Association RepresentativeEMS Association RepresentativeOtherEmail Address* Attending Medical Directors Pre-Conference November 20* Yes No Food Allergies or RequestsNoneVeganNo dairyOther (please contact me)Please email me information about hotel blocks for summit* Yes No Thank you for registering. Information will be sent to the email address above.
