::CONFERENCE REGISTRATION FORM
REGISTRATION FEE: WMS members receive
the lowest rate. Take advantage by signing up
for WMS membership no later than July 1 to
qualify for the discount rate.
CANCELLATIONS: Registration cancellation
must reach the WMS office by July 1, 2006 in
order to receive a refund less a $50 service fee.
After that date, no refunds will be given. The
WMS can not be responsible for any personal
or travel conditions that may prevent
attendance at the conference.
Name ____________________________________________________ ___________________________________
Title/Credentials on Badge
Address ______________________________________________________________________________________
City _____________________________________________________ State _____ Zip/Postal Code _____________
Contact Telephone # _______________________________ E-mail _______________________________________
WMS Member ____ Yes
Member # __________
WMS Member
Non-Member
Amount
Doctoral
$520
$620
$_________
Non-Doctoral
$375
$475
$_________
Resident/Student
$195
$295
$_________
AWLS Pre-Conference Course on Friday &
$425 - Physician
$_________
Saturday, July 21 & 22, 7:30am -5:00pm
$150 - EMT/Resident $_________
$200 - RN/PA
$_________
(One banquet ticket included with registration fee ) All Attendees
Additional Awards Banquet Tickets, 6:00pm - 10:00p
$39
$_________
I need ___ tickets for the July 16 banguet
Head Table Banquet Tickets
,
6:00pm - 10pm
$100
$______
I need ___ tickets for the July 16 banguet
Run for Research on Tuesday, July 25,
$25
$_________
4:15pm - 6:00pm
Symposium - International Medical Travel on
$75
$_________
Saturday, July 25, 1:00pm - 4:00pm
Optional Workshops (mark specific day)
Price
Amount
Survival 1: Surviving An Unexpected Night Out
$__________
______Saturday ______Sunday
$90
Map and Compass Navigation
______Saturday ______Tuesday
$75
$_________
Improvised Splinting
______Saturday ______Monday
$25
$_________
Medical Volunteering in Developing Countries
______Saturday ______Tuesday
$50
$_________
Litters and Packaging
______Saturday ______Monday
$25
$_________
The Role of the Physian Advisor
______Sunday
$25
$_________
Avoid Decision Traps in the Backcountry
______Sunday
$40
$_________
GPS Navigation
______Sunday ______Monday
$75
$_________
Fly Fishing Parts 1 & 2
______Sunday & Monday
$75
$_________
Survival 2: Beyond the Unexpected Night Out
______Monday
$90
$_________
Fix Your Own Back pain
______Monday
$80
$_________
Kids Survival
______Monday
$60
$_________
Streches that Harm, Streches that Help
______Tuesday
$65
$_________
Assessment & Treatment of Wilderness
Envenoming______Tuesday
$75
$_________
Core Training for the Outback
______Tuesday
$40
$_________
Wilderness Medicine Annual Meeting
Total $_____________
My check is enclosed and payable to the Wilderness Medical Society
Charge to my Visa/MasterCard ________________________________________________
Expiration Date _______________ Signature _____________________________________
ACCREDITATION
The Wilderness Medical Society (WMS) is accredited by the Accreditation
Council for Continuing Medical Education to sponsor continuing medical
education for physicians. The WMS designates this educational activity for a
maximum of 39.75 hours, including the AWLS pre-conference course. Each
physician should claim only those hours of credit actually spent in the
educational activity.
Contact the WMS office for information about ACEP & AAFP credits.
NURSES State nursing boards in general may recognize and accept Category 1
credit. Please verify with your state board for validation.
PROGRAM OBJECTIVES
The conference is planned for healthcare professionals, search and rescue
personnel, and anyone interested in wilderness medicine. There are no
prerequisites to attend this conference, which is designed to be thoroughly
practical with new topics and updates from recognized experts. After the
successful completion of attending this conference, the participants will be
able to:
Demonstrate increased awareness of medical problems unique to the
wilderness environment
Prevent, diagnose, and manage illnesses and injuries in remote
wilderness situations
Make appropriate evacuation decisions
Improve techniques for splinting, bandaging, and evacuation from available
equipment and supplies
REGISTRATION
Advance registration is strongly suggested due to limited space availability for
many of the program offerings. Registration fees include a syllabus CD in digital
format, reception, and continental breakfast.
Register on our secure website www.wms.org,
by telephone 800-627-0629, or by fax 785-843-1274.
Mail to WMS, 810 East 10th,
Lawrence, KS 66044
Tracking Code: SN06
