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"EMS: Under Fire" Hilton America’s
Hotel IAFF Federal ID No. 53-0088290 THREE WAYS TO REGISTER: Online: ONLINE REGISTRATION IS NOW CLOSED. FAX:
Registration form to (202) 783-4570 Mail:
Registration form and check or copy of
Purchase Order to:
REGISTRATION The registration fee for the 2007 Dominick Barbera EMS Conference is $375 per person. You can register online at www.iaff.org with Visa or MasterCard only. For mail registration, send form and check payment to: IAFF TA & IR Division, Attn: Beverly Lewis, 1750 New York Avenue, NW, Washington, DC 20006. If using a credit card, you may fax your form to Beverly Lewis at (202) 783-4570. The cut-off to accept registrations online, by fax or through mail is June 15, 2005. You may register onsite at the hotel after that date. FIREPAC CONTRIBUTION Become a FIREPAC Leadership Trust or Founder’s Circle member and automatically register for the EMS Conference in one easy step. The FIREPAC option is only available to IAFF members. Federal election law prohibits the solicitation of non-IAFF members. IAFF members selecting the FIREPAC option must pay by personal check or credit card. Federal election law prohibits FIREPAC from accepting union or corporate money. One person cannot write a personal check or use a personal credit card to cover multiple registrants contributing to FIREPAC. Contributions to FIREPAC are not tax deductible. 1) FIREPAC Leadership Trust ($500 and above) 2) FIREPAC Founder’s Circle U.S. members: Make your personal, voluntary contribution of $500 (personal check, money order or credit card) payable to FIREPAC. One registration form per individual. Canadian members: Make your personal, voluntary contribution of $500 (USD) (personal check, money order, or credit card) payable to FIREPAC Canada. One registration form per individual. All members of FIREPAC’s Leadership Trust ($500) and Founder’s Circle ($375) will receive a specially selected gift. Payment:
REGISTRATION FEE CANCELLATION/REFUND
POLICY Cancel prior to June 15, 2007, to receive a refund of your registration. Any request for refunds must be made in writing and sent to the IAFF TA & IR Division, Attn: Beverly Lewis, 1750 New York Avenue, NW, Washington, DC 20006 or via fax at (202) 783-4570. For paid registrants who can not attend the Conference due to an unforeseen event, you must request a refund in writing by July 30, 2005. No refunds will be issued after that date. Please MAIL or FAX Registration
Form. PARTICIPANT(S)
ATTENDING: CONTACT INFORMATION:
NAME: __________________________________________________________ ADDRESS: _______________________________________________________ EMAIL:______________________________ Local #:_________________ IAFF MEMBER # (does not apply to Guest):_____________________________ TITLE: ___ President ___ Vice President ___ Secretary-Treasurer ___ Executive Board ___ Member ___ Guest* *All guests must be invited by the IAFF affiliate president.
PARTICIPANT
WORKSHOP SELECTION: Participant Name:___________________________________________ Workshop Session
I_________________________________
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