REGISTRATION FOR: "ADVANCED CONCEPTS OF O.B. TRANSPORT"
August 16 & 17, 2010

CLASS HOSTED BY:  Omniflight Helicopters, Mesa, AZ

 

NAME: ____________________________________________________________________________

MAILING ADDRESS:  ________________________________________________________________

CITY / STATE / ZIP: __________________________________________________________________

HOME / CELL /or BEEPER: _________________________________________________________

E-MAIL ADDRESS: __________________________________________________________________

EMPLOYER NAME: __________________________________________________________________

EMPLOYER ADDRESS: _______________________________________________________________

EMPLOYER PHONE: _________________________________________________________________

CHECK ALL THAT APPLIES:

_______ RN       _______PARAMEDIC      _______ EMT      _______ RT

LICENSE NUMBER FOR ABOVE: ______________________________________________________

All materials are protected under: © copyright 1992. 2002, O.B. STAT, Inc
NO reproductions including photocopying, audio or videotaping is allowed.
I understand and agree to abide by all copyright rules when attending this class.

Signature of attendee: _______________________________________________

 

Make checks payable to:
 
O.B. STAT, Inc.
Send to:
  
23 Turnberry Drive
Arden, North Carolina 28704
(828) 684-1708 OFFICE
(828) 684-5545 FAX

REGISTRATION: $275.00 for outside guests - Payments must be received in the O.B. STAT office by no later than Aug 6, 2010
(Credit card payment is not accepted at this time) All registrations are final, non-refundable, non-transferable.

***LATE REGISTRATION is not accepted for this class.
***NOTE: PLEASE FAX, CALL, OR SEND REGISTRATION FORM PRIOR TO Aug 6, 2010
DUE TO LIMITED SPACE IN CLASS. First registrations received will be accepted!!

All class materials and syllabus will be distributed on Day 1 during registration.
Registration begins @ 8:15 am with class beginning promptly @ 8:30.