Registration Type
Choose one:
Note: Resident's must submit letter from program
Registration for optional Ultrasound Course
Personal Information
First Name:
Last Name:
Address:
Address (con't):
City:
State/Province:
Zip/Postal Code:
Country:
Degree (optional):
Phone:
Email Address:
Email Address Again:

 

 
Billing Information
I will pay by:
Credit Card Information
Card Type:
Name on Card:
Card Number:
Exp. Date:
Additional Notes:

 

Before you click the "Register Now!" button below, please proof your information. Correct any spelling errors and please be sure your e-mail address and telephone number are correct. If you do not hear from us, this is probably why. Please note: If paying by check, your payment must reach our offices within 14 days of receipt of this registration or your registration will be cancelled.

Meeting registration contact: Jan Larsen WaACEP

Toll Free 800-552-0612 ex 3026 Fax 360-738-7138 mailto:jal@wsma.org