How to Register
EARLY BIRD SPECIAL
Register by 03/01/04
and receive a 10%
discount!
To
join WMS visit our
website a
t
www
.wms.org
Wilderness Medical Society
International Summer Conference on
Wilderness Medicine
Snowmass at Aspen, Colorado · July 31August 6, 2004
ONLINE:
www.wms.org
FAX:
800.967.7494
MAIL:
Wilderness Medical Society
5390 N. Academy Blvd., Ste. 310
Colorado Springs, CO 80918
PHONE:
719.572.1372
Please print or type. Form may be photocopied.
WMS Member Number: ___________________________________
Name: _______________________________________________
First
MI
Last
Degree(s): ____________________________________________
Address:______________________________________________
___________________________________________________
City
State/Providence
Zip/Postal
___________________________________________________
Country
E-mail:_______________________________________________
Tel: ( ) _________________________________________
Fax: ( ) _________________________________________
Specialty: _____________________________________________
We want you to enjoy this WMS program. Please let us know of any special
requirements you have:
___________________________________________________
___________________________________________________
Conference Registration
WMS members pay the lowest rate. To take advantage of this rate,
your membership must be current as of February 20, 2004
.
Rate
Member
Non-Member
Doctoral
$495
$595
Non-Doctoral/Resident*
$295
$395
Student*
$195
$295
*Validation of student or resident status required with registration.
Summary of Payment
Conference Registration Fee (see categories above)
$ _______________
Early Bird Discount Register by 03/01/04
-10%
$ _______________
Team Discount (3 or more)
-10%
$ _______________
(20% discount if both apply. For Conference Registration Fee only.)
Pre-Conference Symposium:
Controversies in High Altitude Medicine
$50
$ _______________
Optional Workshops:
Surviving Wilderness Emergencies
$80
$ _______________
Sat. Sun. Mon. Tues. Wed.
Map and Compass Navigation
$75
$ _______________
Mon. Wed.
ABCs of GPS Navigation
$75
$ _______________
Tues. Thurs.
No More Back Pain
$75
$ _______________
Medical Volunteering in the 3rd World
$45
$ _______________
Sat. Sun.
Photographing Wildlife and Wild Places
$200
$ _______________
Ultrasound in the Wilderness
$75
$ _______________
1:30 3:30
Fly Fishing
$65
$ _______________
Helicopters in Mountain Rescue
$40
$ _______________
Alpine Climbing 101
$125
$ _______________
Backcountry Travel Secrets
$65
$ _______________
Ancient Arts
$65
$ _______________
Reading Animal Signs
$65
$ _______________
Fire by Friction
$65
$ _______________
Kids' Program:
Wilderness Survival for Kids
$50
$ _______________
Mon. Tues.
Wilderness First Aid for Kids
FREE
$ _______________
Post-Conference Workshops:
Mountain Overnight Survival
$195
$ _______________
Thur. & Fri. Sat. & Sun.
Total
$ _______________
Check enclosed. Make checks (payable in U.S. funds) payable to:
Wilderness Medical Society
or Charge to: Visa MasterCard
Acct.#: __________________________________ Exp. Date:___________
Signature: ___________________________________________________
Note: if your registration must be cancelled, a refund less $100
will be allowed if requested in writing by 07/03/04. We
regret that refunds will not be allowed after that date.
Disclosure
Faculty members for the International Summer Conference on
Wilderness Medicine are expected to disclose, at the begin-
ning of their presentation(s), any economic or other personal
interests that create, or may be perceived as creating, a con-
flict related to the material discussed. This policy is intended
to make participants aware of the faculty's interests, so they
may form their own judgments about such material.
Accreditation
The Wilderness Medical Society is accredited by the
Accreditation Council for Continuing Medical Education to
sponsor continuing medical education for physicians.
The Wilderness Medical Society designates this educational
activity for a maximum of 21 hours (with additional credit for
Optional Workshops) in category 1 credit towards the AMA
Physician's Recognition Award. Each physician should claim
only those hours of credit that he/she actually spent in the
educational activity
ACEP:
The International Summer Conference on Wilderness
Medicine is approved by the American College of Emergency
Physicians for 21 hours of ACEP Category 1 credit.
AAFP:
The International Summer Conference on Wilderness
Medicine has been reviewed and is acceptable for up to 21
hours prescribed credit by AAFP.
Please contact the WMS office for additional accreditation
information.
NURSES:
State nursing boards may accept Catagory 1 credit. Please
check with yours for the necessary steps.
Conference Registration
WMS members pay the lowest rate. To take advantage of this rate,
your membership must be current as of February 20, 2004.
Rate
Member
Non-Member
Doctoral
$495
$595
Non-Doctoral/Resident*
$295
$395
Student*
$195
$295
*Validation of student or resident status required with registration.
