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July 2008 Seminar Registration Form
Print out and return this form to register for this Seminar.
"CAAS Accreditation Seminar"
July 24, 2008
8:00 a.m. to 5:00 p.m.
Hilton St. Louis at the Ballpark
St. Louis, Missouri
Final Registration Deadline Extension: June 30th, 2008
Company________________________________________________________________
Address________________________________________________________________
City_____________________________ State________ Zip____________________
Country________________________________________________________________
Phone ( )____________________ Fax ( )____________________
E-mail_________________________________________________________________
Provider Type (please check one): ___County ___Fire Department ___Hospital
___Municipal ___Police ___Private ___Public Service ___Public Trust
___Third Service ___Public Utility Model
Total # of medical transports per year: ___________________
Workshop Attendees:
1._________________________________ 3._________________________________
2._________________________________ 4._________________________________
First Registration: _____ x $295.00 (US Dollars) _________
*Each Additional Registration: _____ x $275.00 (US Dollars) _________
*To qualify for this discount, registration must be received together and paid on the same check.
Please check one:
____ We are seeking accreditation in 2008.
____ We are seeking accreditation in 2009.
____ We are seeking accreditation in 2010
____ We are a re-accrediting agency.
METHOD OF PAYMENT:
____ Check (Payable to CAAS)
____ American Express
____ Visa
____ Mastercard
Card Number__________________________ Expiration Date__________________
Signature____________________________ Name on Card_____________________
Cancellation Policy: If it is necessary to cancel the registration, (1) an alternate may be named by the agency with no penalty or (2) the registration fee will be credited to a future CAAS Accreditation Seminar
Return form to:
1926 Waukegan Road, Suite 1
Glenview, IL 60025-1770
or fax credit card registrations only to (847) 657-6825.
If you have any questions, please call (847) 657-6828 or e-mail: marciem@tcag.com.
___ Check here if you require special accommodations in order to
attend this meeting, and a CAAS staff member will contact you.