Advancing the EMS profession

Registration Form


Please complete the registration form below to register for the 2021 EMS On The Hill Day. 
 
EMS On The Hill Day - Virtual meetings will occur on April 13, 14 and 15, 2021
 (each state will be assigned a specific day and time window, so you won't need to be available all three days. We will hold a virtual briefing on April 6, 2021, and 30-minute state-specific briefings will be scheduled April 6-8, 2021.  

Early-bird Registration is only $20 until March 1, and $40 after March 1, 2021.  
Registration is non-refundable due to the fact that costs are incurred upon registration to the event.
Registration is open until March 26, 2021.  

For questions regarding registration, contact Cindy Bussell at Cindy.Bussell@naemt.org or 317-745-0804.


 
EMS On The Hill Day Registrants:
Your HOME ADDRESS is required on the registration form and will be used to identify your Members of Congress and schedule your virtual meetings accordingly. Please include your CELL NUMBER in case we need to reach you during the event.


 
PERSONAL INFORMATION
 
First Name *
Last Name *
Middle Initial
 
  Home Address
Street *
City *
State*
Zip*
 
Cell Number*
E-mail Address*
 
PROFESSIONAL INFORMATION
 
EMS Agency or Organization*  If not applicable, enter N/A    
Title
Medical Position*
   

Additional EMS On The Hill Day Information

For 2021, EMS On The Hill Day participants will have up to three virtual meetings: one with the Member who represents you in the House of Representatives, and one with each of the two Senators who represent your state. If there are additional Members of Congress with whom you have a relationship, please let us know below. Please note that NAEMT cannot guarantee you will be able to join meetings with additional Members. 


Please enter additional information as described above here. (500 character limit)

If there is any other information you would like to share, please do so here. (500 character limit)

I understand and agree that photos and images from EMS On The Hill Day may be published and used for future promotions of the event.


REGISTRATION
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