Name _______________________________________________________________________________________
First
MI Last Degree/Credentials
First Name to Appear on Badge ________________________Occupation/Specialty _________________________
(if different from above)
Mailing Address _______________________________________________________________________________
City _________________________________State/Province________ Zip/Postal Code __________Country_______
Contact Telephone # _______________________________ E-mail _______________________________________
WMS Member Yes No If Yes, Member # ____________________________________________________
Have you attended past WMS meeting(s)? Yes No If yes, how many? 1 2-5 6-10 > 10
::geneRaL Info
DATES
Saturday Wednesday, July 21-25, 2007
(AWLS begins on Friday, July 20)
CONFERENCELOCATION
Snowmass Conference Center
(adjacent to Silvertree Hotel &
Wildwood Lodge)
Snowmass, Colorado
LODGINGRESERVATIONS
Silvertree Hotel
800-837-4255
Other Lodging
visit www.wms.org for Links
WHOWILLATTEND
Physicians, nurses, physician assistants,
nurse practitioners, EMTs, paramedics,
search and rescue personnel, and other
interested health professionals and
prehospital personnel with special
interest in the medical issues of the
wilderness environment. There are no
prerequisites for this course.
ENROLLEARLY!
Early registration is strongly
encouraged due to limited space
availability for AWLS and many of the
optional workshops.
REGISTRATIONFEES
The course tuition includes lectures,
Wednesday morning concurrent
sessions, syllabus, certificate of
completion, continental breakfasts,
welcome reception and banquet.
Please see adjacent Registration Form
for a complete listing of fees.
CANCELLATIONAND
REFUNDPOLICY
The course tuition is refundable, less
a $100 processing fee, if cancellation
is received in writing no later than
June 29, 2007. No refunds will be
given after that date. The WMS cannot
be responsible for any personal or
travel conditions that may prevent
attendance at the conference.
SPECIALNEEDS
The Wilderness Medical Society fully
complies with the legal requirements
of the Americans with Disabilities Act.
If you have special needs, please notify
the WMS at least three weeks prior to
the conference.
::RegIstRatIon/MeMbeRshIP foRM
Before June 1
After June 1
Subtotal
WMS Member*
Non-Member
WMS Member*
Non-Member
A. CoNFErENCE
Doctoral
$570
$670
$620
$720
Non-Doctoral
$395
$470
$445
$520
Resident/Student
$225
$275
$275
$325
A.
__________
B. PrE-CoNFErENCE
Toxicology Symposium
$75
AWLS
$425 Doctoral
$300 Non-Doctoral
$150 Resident/Student
B.
__________
C. oPTioNAl workshoPs (MARK SPECIFIC DAY)
Core Training in the Outback
Tuesday
$50
Fly Fishing - 2 Part
Sunday & Monday
$75
GPS Navigation
Sunday
Tuesday
$75
Improvised Splinting
Saturday
Monday
$25
Litters & Packaging
Saturday
Monday
$25
Maps & Compass Navigation
Saturday
Monday
$75
Medical Volunteering in Developing Countries
Saturday
Tuesday
$50
Photographing Wildlife and Wildplaces - 2 Part
Monday & Tuesday
$175
Stretches that Harm, Stretches that Help
Tuesday
$50
Surviving the Unexpected Night Out 101
Saturday
Sunday
$90
Survival: Beyond the Unexpected Night Out
Monday
$90
C.
__________
D. ADDiTioNAl ACTiviTiEs
Kids Survival Workshop - Monday, July 23
$_______ (#______Children @ $60 ea.)
Run for Research - Tuesday, July 24
$_______ (#______Entrants @ $50 ea.)
WMS Banquet - Tuesday, July 24
$_______ (#______Tickets @ $39 ea.)
D.
__________
(one ticket included with registration)
*E. wilDErNEss mEDiCAl soCiETy mEmBErshiP
*If you are not a current member of the WMS , join now to take advantage of reduced conference
fees for members, to support the Society and to enjoy the benefits of membership for one year.
$160 Doctoral
$100 Non-Doctoral
$75 Resident
$50 Student
E.
__________
PAymENT mEThoD
ToTAl DUE:
$__________
Check Payable (US funds) to Wilderness Medical Society
MasterCard Visa
Acct. #:__________________________________________Exp. Date:___________________
Name on Card: ______________________________________________________________
Signature:__________________________________________________________________
FOUREASYWAYSTOREGISTER:
ONLINE: WWW.WMS.ORG
FAX: 785-843-1274
PHONE: 800-627-062EXT.225
MAIL: WMS
810EAST10THST.
LAWRENCE,KS66044
::4 waYs to RegIsteR
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