Registrant Demographic

Last Name *

First Name *

Address *

City *

State *

Zip *

Phone Number *

Email Address *

Name on Badge

Employer

Print your Employer on Name Badge

Yes

No

Chapter Affiliation:

Certification Number

Core Conference

Thursday June 12, 2025, to Saturday June 14, 2025

*Individual Conference Registration

Before May 1 ($150.00)

After April 30 ($175.00)

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includes educational sessions, handouts, banquets, select meals, and social events. ALSO INCLUDES MANDATORY MEMBERSHIP TO ATTEND CONFERENCE

Membership Discount

Add your LANREMT membership number to receive a conference discount.

How to find my ID Number

*EMS Awards Banquet (only) ($30.00 each)

Spouse/Partner/Guest Meal for Banquet

*Group Registration

Group Registration (1-5) ($500.00)

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Includes education sessions, lunches, and banquet dinners for each registrant More than 5 add $120.00 each. Please complete the form for each attendee.

*Additional Group Conference Registration

This is 1 additional over the 5-member group registration up to 5 additional members

*Military Rate

Before May 1 ($125.00)

After April 30 ($150.00)

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*One Day Registrations

Thursday June 12, 2025 ($100.00)

Friday June 12, 2025 ($100.00)

Saturday June 13, 2025 ($100.00)

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*Conference Fee Total

On-site Conference registration will be $200.00

Additional Squad Registration 2-5

Squad Member #2

Last Name #2

First Name #2

Address #2

City #2

State #2

Zip #2

Phone Number #2

Email Address #2

Name on Badge 2

Employer #2

Print your Employer on Name Badge #2

Yes

No

Chapter Affiliation: #2

Certification Number 2

Squad Member #3

Last Name #3

First Name #3

Address #3

City #3

State #3

Zip #3

Phone Number #3

Email Address #3

Name on Badge 3

Employer #3

Print your Employer on Name Badge #3

Yes

No

Chapter Affiliation: #3

Certification Number #3

Squad Member #4

Last Name #4

First Name #4

Address #4

City #4

State #4

Zip #4

Phone Number #4

Email Address #4

Name on Badge 4

Employer #4

Print your Employer on Name Badge #4

Yes

No

Chapter Affiliation: #4

Certification Number 4

Squad Member #5

Last Name #5

First Name #5

Address #5

City #5

State #5

Zip #5

Phone Number #5

Email Address #5

Name on Badge 5

Employer #5

Print your Employer on Name Badge #5

Yes

No

Chapter Affiliation: #5

Certification Number 5

Squad Member #6

Last Name #6

First Name #6

Address #6

City #6

State #6

Zip #6

Name on Badge 6

Employer #6

Print your Employer on Name Badge #6

Yes

No

Chapter Affiliation: #6

Certification Number 6

Squad Member #7

Last Name #7

First Name #7

Address #7

City #7

State #7

Zip #7

Phone Number #7

Email Address #7

Name on Badge 7

Employer #7

Print your Employer on Name Badge #7

Yes

No

Chapter Affiliation: #7

Certification Number 7

Squad Member #8

Last Name #8

First Name #8

Address #8

City #8

State #8

Zip #8

Phone Number #8

Email Address #8

Name on Badge 8

Employer #8

Print your Employer on Name Badge #8

Yes

No

Chapter Affiliation: #8

Certification Number 8

Squad Member #9

Last Name #9

First Name #9

Address #9

City #9

State #9

Zip #9

Phone Number #9

Email Address #9

Name on Badge 9

Employer #9

Print your Employer on Name Badge #9

Yes

No

Chapter Affiliation: #9

Certification Number 9

Squad Member #10

Last Name #10

First Name #10

Address #10

City #10

State #10

Zip #10

Phone Number #10

Email Address #10

Name on Badge 10

Employer #10

Print your Employer on Name Badge #10

Yes

No

Chapter Affiliation: #10

Certification Number 10

Payment

Conference Total

Payment Methods *

DoubleTree by Hilton Hotel Lafayette

1521 West Pinhook Road

Lafayette, LA 70503-3158

+1 337-235-6111

Please refer to the Conference Code of LAE

Hotel Conference Rate
Double Beds Nonsmoking---$139.00
King Bed-nonsmoking--------$159.00

Cutoff date May 28, 2025

Louisiana Association of Nationally Registered Emergency Medical TechniciansConference and ExpoJune 12, 2025 toJune 14, 2025

Registrant Demographic

Core Conference

Thursday June 12, 2025, to Saturday June 14, 2025

On-site Conference registration will be $200.00

Additional Squad Registration 2-5

Squad Member #2

Squad Member #3

Squad Member #4

Squad Member #5

Squad Member #6

Squad Member #7

Squad Member #8

Squad Member #9

Squad Member #10

Payment

Louisiana Association of Nationally Registered Emergency Medical Technicians
Conference and Expo
June 12, 2025
to
June 14, 2025