NAMIHP MIH Summit Registration February 16 - 18, 2025 Tampa Marriott Water Street 505 Water Street, Tampa, Florida, USA, 33602 Toll Free: +1-800-228-9290 Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Name *FirstLastEmail *Department/Organization *Job Title *Degree *Select DegreeAddiction ProfessionalAPRNBSNCertified CounselorDMDDODPMEMTFellow/Resident/StudentLaw EnforcementLPNMDMSNNPPAParamedicPhDRNSocial WorkerOtherAddress *Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeCountry *Phone *DemographicsWhat is your job function? *Select optionFirst ResponderBasic Life SupportAdvanced Life SupportManagementAeromedicalOther ClinicalCorporateEducationCommunicationsLaw EnforcementFireOtherJob TitleType of Service *Select optionFire DepartmentMunicipal AgencyPrivate ServiceIndependent ServiceHospitalGovernment, MilitaryEducational, AssociationCommercial, IndustrialOther EMS ProviderManufacturer, Distributer, DealerOtherNo Response your the purchase I recommend, specify, or approve products/services in the following categories (check all that apply) *Disaster ResponseEducation/TrainingEmergency Dept.HazmatManagement/OperationsMobile Healthcare/Community ParamedicineTechnology/ITVehicles or EquipmentOtherNoneI will be recommending, specifying, or approving the following products/services for purchase in the next 12 months (check all that apply) *Administrative/Business ServicesAirway/RespiratoryBatteries, Generators, Invertors, ChargersCardiacCommunications, DispatchCommunity, FundraisingComputer Software/HardwareDiagnostic Medical EquipmentEducation, TrainingEmployment, RecruitmentFacility Equipment/ServicesHazmat, Disaster, MCI, WMDHealth, Fitness, Self-CareInfection ControlInformation Systems/TechnologyIntegrated Healthcare DeliveryInventory ControlMonitors, Pulse OximetersPharmaceuticalsProtective EquipmentRescue & ExtricationTacticalOtherNoneIs this your first-time attending an MIH Summit hosted by NAMIHP? *Select optionNoYesMembershipAre you a NAMIHP member? *YesNoNo, but I'd like to become a MemberYes-Registration for MIH Summit *Registration for MIH Summit - $419.00(Includes MIH Summit and Networking Event Ticket)Yes-Guest Networking Event TicketGuest Networking Event Ticket - $75.00No-Registration for MIH Summit *Registration for MIH Summit - $499.00(Includes MIH Summit and Networking Event Ticket)No-Guest Networking Event TicketGuest Networking Event Ticket - $75.00NAMIHP MembershipPrice: $55.00No but-Registration for MIH SummitRegistration for MIH Summit - $419.00(Includes MIH Summit and Networking Event Ticket)No but-Guest Networking Event TicketGuest Networking Event Ticket - $75.00If you would like bring a spouse or special guest attendee for a specific session, contact NAMIHP at office@namihp.org. Total$0.00Coupon Apply Credit Card Payment *Submit
