{"id":12546,"date":"2025-09-30T09:53:16","date_gmt":"2025-09-30T13:53:16","guid":{"rendered":"https:\/\/cms.umem.org\/?page_id=12546"},"modified":"2025-10-15T20:31:45","modified_gmt":"2025-10-16T00:31:45","slug":"registration-tcp-2025-form","status":"publish","type":"page","link":"https:\/\/cms.umem.org\/index.php\/tcp25-main\/registration-tcp-2025-form\/","title":{"rendered":"REGISTRATION TCP 2025 FORM"},"content":{"rendered":"<div id=\"cs-content\" class=\"cs-content\"><div id=\"x-section-1\" class=\"x-section cs-ta-center\" style=\"margin: 0px;padding: 5px 0px; background-color: hsl(0, 0%, 100%);\" ><div class=\"x-section-separator x-section-separator-top x-section-separator-angle-out\" style=\"top: 0px; height: 50px;\"><svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" version=\"1.1\" viewBox=\"0 0 100 100\" preserveAspectRatio=\"none\" class=\"angle-top-out\" style=\"fill: hsl(0, 0%, 100%);\"><polygon points=\"50,0 100,100 0,100\"\/><\/svg><\/div><div id=\"\" class=\"x-container max width\" style=\"margin: 0px auto;padding: 0px;\" ><div  class=\"x-column x-sm x-1-1\" style=\"padding: 0px;\" ><div class=\"x-row e12546-e4 m9oi-0 m9oi-1 m9oi-3 m9oi-4\"><div class=\"x-row-inner\"><div class=\"x-col e12546-e5 m9oi-6\"><img decoding=\"async\"  class=\"x-img x-img-none\"  src=\"https:\/\/cms.umem.org\/wp-content\/uploads\/2025\/09\/Screenshot-2025-09-30-at-9.04.03-AM.png\" ><h1  class=\"h-custom-headline h2\" style=\"color: hsl(0, 88%, 4%);padding-bottom: 25px;\"><span>REGISTRATION FORM<\/span><\/h1><\/div><\/div><\/div><div class=\"x-row e12546-e8 m9oi-0 m9oi-2 m9oi-3 m9oi-5\"><div class=\"x-row-inner\"><div class=\"x-col e12546-e9 m9oi-6\"><div class=\"x-text x-content e12546-e10 m9oi-8\"><p><span style=\"color: #ff0000;\"><strong>If you have attended a previous UMEM Conference<\/strong><\/span>, you will need to make sure you are logged in with your website account before registering for this course. If you have forgotten your password, you can reset it using the link under the login form.<\/p>\n<p><span style=\"color: #ff0000;\"><em><strong>A reminder that your username is the email address you used to register for previous UMEM events.<\/strong><\/em><\/span><\/p>\n<p><strong>CME: <a href=\"https:\/\/cms.umem.org\/index.php\/tcp23-main\/tcp23-cme\/\">CME information<\/a>.&nbsp;<\/strong><\/p>\n<p><strong>Registration Pricing &amp; Information;<\/strong><\/p>\n<ul>\n<li><strong>$400 for physicians&nbsp;<\/strong><\/li>\n<li><strong>$200 for allied health professionals&nbsp;<\/strong><\/li>\n<li><strong>$50 for residents\/medical students\/EMTs\/Active Military&nbsp;<\/strong><\/li>\n<\/ul>\n<p><strong>Discounts:&nbsp;<\/strong><\/p>\n<p>Early bird discount of 10% off is provided until October 31st with coupon code <strong>EBTCP2025<\/strong>. Discounts available for residency programs.<\/p>\n<p>Email <strong><span style=\"color: #0000ff;\"><a style=\"color: #0000ff;\" href=\"mailto:dlucadamo@som.umaryland.edu\">umem.conferences@som.umaryland.edu<\/a><\/span><\/strong><\/p><\/div><\/div><div class=\"x-col e12546-e11 m9oi-6 m9oi-7\"><div class=\"x-content-area e12546-e12 m9oi-9\"><p><span style=\"color: #000000;\"><strong><em>If you did not attend a prior UMEM conference (eg, The Crashing Patient 2020-2024, Emergency Cardiology Symposium 2021-2025 or Critical Care Symposium 2021-2025 please skip this login section. You will be asked to set a username and password in the below form.<\/em><\/strong><\/span><\/p>\n<p>If you have attended any previous conferences between 2020-2025, you should have a log in. Therefore, please complete the below log in information. If you have questions, contact us at <a href=\"mailto:umem.conferences@som.umaryland.edu\">umem.conferences@som.umaryland.edu<\/a>.<\/p>\n<p>\n<div class=\"mp_wrapper mp_login_form\">\n                  <!-- mp-login-form-start -->     <form name=\"mepr_loginform\" id=\"mepr_loginform\" class=\"mepr-form\" action=\"https:\/\/cms.umem.org\/index.php\/login\/\" method=\"post\">\n            <div class=\"mp-form-row mepr_username\">\n        <div class=\"mp-form-label\">\n                              <label for=\"user_login\">Username<\/label>\n        <\/div>\n        <input type=\"text\" name=\"log\" id=\"user_login\" value=\"\" \/>\n      <\/div>\n      <div class=\"mp-form-row mepr_password\">\n        <div class=\"mp-form-label\">\n          <label for=\"user_pass\">Password<\/label>\n          <div class=\"mp-hide-pw\">\n            <input type=\"password\" name=\"pwd\" id=\"user_pass\" value=\"\" \/>\n            <button type=\"button\" class=\"button mp-hide-pw hide-if-no-js\" 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href=\"https:\/\/cms.umem.org\/index.php\/login\/?action=forgot_password\"\n          title=\"Click here to reset your password\"\n        >\n          Forgot Password        <\/a>\n    <\/div>\n\n      \n    <!-- mp-login-form-end --> \n  <\/div>\n<\/p><\/div><\/div><\/div><\/div><\/div><\/div><div id=\"\" class=\"x-container max width\" style=\"margin: 0px auto;padding: 0px;\" ><div  class=\"x-column x-sm cs-ta-left x-1-1\" style=\"padding: 0px;\" ><hr  class=\"x-gap\" style=\"margin: 50px 0 0 0;\"><script type=\"text\/javascript\">\n\/* <![CDATA[ *\/\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof 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gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_57_1'>\n                            \n                            <span id='input_57_1_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_1.3' id='input_57_1_3' value='' tabindex='2'  aria-required='true'     \/>\n                                                    <label for='input_57_1_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_57_1_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_1.6' id='input_57_1_6' value='' tabindex='4'  aria-required='true'     \/>\n                                                    <label for='input_57_1_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><fieldset id=\"field_57_2\" class=\"gfield gfield--type-email gfield--input-type-email gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Email<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container_email gform-grid-row' id='input_57_2_container'>\n                                <span id='input_57_2_1_container' class='ginput_left gform-grid-col gform-grid-col--size-auto'>\n                                    <input class='' type='email' name='input_2' id='input_57_2' value='' tabindex='6'   aria-required=\"true\" aria-invalid=\"false\"  \/>\n                                    <label for='input_57_2' class='gform-field-label gform-field-label--type-sub '>Enter Email (This will be your USERNAME used for log-in)<\/label>\n                                <\/span>\n                                <span id='input_57_2_2_container' class='ginput_right gform-grid-col gform-grid-col--size-auto'>\n                                    <input class='' type='email' name='input_2_2' id='input_57_2_2' value='' tabindex='7'   aria-required=\"true\" aria-invalid=\"false\"  \/>\n                                    <label for='input_57_2_2' class='gform-field-label gform-field-label--type-sub '>Confirm Email<\/label>\n                                <\/span>\n                                <div class='gf_clear gf_clear_complex'><\/div>\n                            <\/div><\/fieldset><div id=\"field_57_29\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_57_29'>Phone Number<\/label><div class='ginput_container ginput_container_text'><input name='input_29' id='input_57_29' type='text' value='' class='medium'   tabindex='8'   aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_57_12\" class=\"gfield gfield--type-address gfield--input-type-address gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip has_country ginput_container_address gform-grid-row' id='input_57_12' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_57_12_1_container' >\n                                        <input type='text' name='input_12.1' id='input_57_12_1' value='' tabindex='9'   aria-required='true'    \/>\n                                        <label for='input_57_12_1' id='input_57_12_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                    <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_57_12_2_container' >\n                                        <input type='text' name='input_12.2' id='input_57_12_2' value='' tabindex='10'    aria-required='false'   \/>\n                                        <label for='input_57_12_2' id='input_57_12_2_label' class='gform-field-label gform-field-label--type-sub '>Address Line 2<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_57_12_3_container' >\n                                    <input type='text' name='input_12.3' id='input_57_12_3' value='' tabindex='11'   aria-required='true'    \/>\n                                    <label for='input_57_12_3' id='input_57_12_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_57_12_4_container' >\n                                        <input type='text' name='input_12.4' id='input_57_12_4' value='' tabindex='13'     aria-required='true'    \/>\n                                        <label for='input_57_12_4' id='input_57_12_4_label' class='gform-field-label gform-field-label--type-sub '>State \/ Province \/ Region<\/label>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_57_12_5_container' >\n                                    <input type='text' name='input_12.5' id='input_57_12_5' value='' tabindex='14'   aria-required='true'    \/>\n                                    <label for='input_57_12_5' id='input_57_12_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP \/ Postal Code<\/label>\n                                <\/span><span class='ginput_right address_country ginput_address_country gform-grid-col' id='input_57_12_6_container' >\n                                        <select name='input_12.6' id='input_57_12_6' tabindex='15'  aria-required='true'    ><option value='' ><\/option><option value='Afghanistan' >Afghanistan<\/option><option value='Albania' >Albania<\/option><option value='Algeria' >Algeria<\/option><option value='American Samoa' >American Samoa<\/option><option value='Andorra' >Andorra<\/option><option value='Angola' >Angola<\/option><option value='Anguilla' >Anguilla<\/option><option value='Antarctica' >Antarctica<\/option><option value='Antigua and Barbuda' >Antigua and Barbuda<\/option><option value='Argentina' >Argentina<\/option><option value='Armenia' >Armenia<\/option><option value='Aruba' >Aruba<\/option><option value='Australia' >Australia<\/option><option value='Austria' >Austria<\/option><option value='Azerbaijan' >Azerbaijan<\/option><option value='Bahamas' >Bahamas<\/option><option value='Bahrain' >Bahrain<\/option><option value='Bangladesh' >Bangladesh<\/option><option value='Barbados' >Barbados<\/option><option value='Belarus' >Belarus<\/option><option value='Belgium' >Belgium<\/option><option value='Belize' >Belize<\/option><option value='Benin' >Benin<\/option><option value='Bermuda' >Bermuda<\/option><option value='Bhutan' >Bhutan<\/option><option value='Bolivia' >Bolivia<\/option><option value='Bonaire, Sint Eustatius and Saba' >Bonaire, Sint Eustatius and Saba<\/option><option value='Bosnia and Herzegovina' >Bosnia and Herzegovina<\/option><option value='Botswana' >Botswana<\/option><option value='Bouvet Island' >Bouvet Island<\/option><option value='Brazil' >Brazil<\/option><option value='British Indian Ocean Territory' >British Indian Ocean Territory<\/option><option value='Brunei Darussalam' >Brunei Darussalam<\/option><option value='Bulgaria' >Bulgaria<\/option><option value='Burkina Faso' >Burkina Faso<\/option><option value='Burundi' >Burundi<\/option><option value='Cabo Verde' >Cabo Verde<\/option><option value='Cambodia' >Cambodia<\/option><option value='Cameroon' >Cameroon<\/option><option value='Canada' >Canada<\/option><option value='Cayman Islands' >Cayman Islands<\/option><option value='Central African Republic' >Central African Republic<\/option><option value='Chad' >Chad<\/option><option value='Chile' >Chile<\/option><option value='China' >China<\/option><option value='Christmas Island' >Christmas Island<\/option><option value='Cocos Islands' >Cocos Islands<\/option><option value='Colombia' >Colombia<\/option><option value='Comoros' >Comoros<\/option><option value='Congo' >Congo<\/option><option value='Congo, Democratic Republic of the' >Congo, Democratic Republic of the<\/option><option value='Cook Islands' >Cook Islands<\/option><option value='Costa Rica' >Costa Rica<\/option><option value='Croatia' >Croatia<\/option><option value='Cuba' >Cuba<\/option><option value='Cura\u00e7ao' >Cura\u00e7ao<\/option><option value='Cyprus' >Cyprus<\/option><option value='Czechia' >Czechia<\/option><option value='C\u00f4te d&#039;Ivoire' >C\u00f4te d&#039;Ivoire<\/option><option value='Denmark' >Denmark<\/option><option value='Djibouti' >Djibouti<\/option><option value='Dominica' >Dominica<\/option><option value='Dominican Republic' >Dominican Republic<\/option><option value='Ecuador' >Ecuador<\/option><option value='Egypt' >Egypt<\/option><option value='El Salvador' >El Salvador<\/option><option value='Equatorial Guinea' >Equatorial Guinea<\/option><option value='Eritrea' >Eritrea<\/option><option value='Estonia' >Estonia<\/option><option value='Eswatini' >Eswatini<\/option><option value='Ethiopia' >Ethiopia<\/option><option value='Falkland Islands' >Falkland Islands<\/option><option value='Faroe Islands' >Faroe Islands<\/option><option value='Fiji' >Fiji<\/option><option value='Finland' >Finland<\/option><option value='France' >France<\/option><option value='French Guiana' >French Guiana<\/option><option value='French Polynesia' >French Polynesia<\/option><option value='French Southern Territories' >French Southern Territories<\/option><option value='Gabon' >Gabon<\/option><option value='Gambia' >Gambia<\/option><option value='Georgia' >Georgia<\/option><option value='Germany' >Germany<\/option><option value='Ghana' >Ghana<\/option><option value='Gibraltar' >Gibraltar<\/option><option value='Greece' >Greece<\/option><option value='Greenland' >Greenland<\/option><option value='Grenada' >Grenada<\/option><option value='Guadeloupe' >Guadeloupe<\/option><option value='Guam' >Guam<\/option><option value='Guatemala' >Guatemala<\/option><option value='Guernsey' >Guernsey<\/option><option value='Guinea' >Guinea<\/option><option value='Guinea-Bissau' >Guinea-Bissau<\/option><option value='Guyana' >Guyana<\/option><option value='Haiti' >Haiti<\/option><option value='Heard Island and McDonald Islands' >Heard Island and McDonald Islands<\/option><option value='Holy See' >Holy See<\/option><option value='Honduras' >Honduras<\/option><option value='Hong Kong' >Hong Kong<\/option><option value='Hungary' >Hungary<\/option><option value='Iceland' >Iceland<\/option><option value='India' >India<\/option><option value='Indonesia' >Indonesia<\/option><option value='Iran' >Iran<\/option><option value='Iraq' >Iraq<\/option><option value='Ireland' >Ireland<\/option><option value='Isle of Man' >Isle of Man<\/option><option value='Israel' >Israel<\/option><option value='Italy' >Italy<\/option><option value='Jamaica' >Jamaica<\/option><option value='Japan' >Japan<\/option><option value='Jersey' >Jersey<\/option><option value='Jordan' >Jordan<\/option><option value='Kazakhstan' >Kazakhstan<\/option><option value='Kenya' >Kenya<\/option><option value='Kiribati' >Kiribati<\/option><option value='Korea, Democratic People&#039;s Republic of' >Korea, Democratic People&#039;s Republic of<\/option><option value='Korea, Republic of' >Korea, Republic of<\/option><option value='Kuwait' >Kuwait<\/option><option value='Kyrgyzstan' >Kyrgyzstan<\/option><option value='Lao People&#039;s Democratic Republic' >Lao People&#039;s Democratic Republic<\/option><option value='Latvia' >Latvia<\/option><option value='Lebanon' >Lebanon<\/option><option value='Lesotho' >Lesotho<\/option><option value='Liberia' >Liberia<\/option><option value='Libya' >Libya<\/option><option value='Liechtenstein' >Liechtenstein<\/option><option value='Lithuania' >Lithuania<\/option><option value='Luxembourg' >Luxembourg<\/option><option value='Macao' >Macao<\/option><option value='Madagascar' >Madagascar<\/option><option value='Malawi' >Malawi<\/option><option value='Malaysia' >Malaysia<\/option><option value='Maldives' >Maldives<\/option><option value='Mali' >Mali<\/option><option value='Malta' >Malta<\/option><option value='Marshall Islands' >Marshall Islands<\/option><option value='Martinique' >Martinique<\/option><option value='Mauritania' >Mauritania<\/option><option value='Mauritius' >Mauritius<\/option><option value='Mayotte' >Mayotte<\/option><option value='Mexico' >Mexico<\/option><option value='Micronesia' >Micronesia<\/option><option value='Moldova' >Moldova<\/option><option value='Monaco' >Monaco<\/option><option value='Mongolia' >Mongolia<\/option><option value='Montenegro' >Montenegro<\/option><option value='Montserrat' >Montserrat<\/option><option value='Morocco' >Morocco<\/option><option value='Mozambique' >Mozambique<\/option><option value='Myanmar' >Myanmar<\/option><option value='Namibia' >Namibia<\/option><option value='Nauru' >Nauru<\/option><option value='Nepal' >Nepal<\/option><option value='Netherlands' >Netherlands<\/option><option value='New Caledonia' >New Caledonia<\/option><option value='New Zealand' >New Zealand<\/option><option value='Nicaragua' >Nicaragua<\/option><option value='Niger' >Niger<\/option><option value='Nigeria' >Nigeria<\/option><option value='Niue' >Niue<\/option><option value='Norfolk Island' >Norfolk Island<\/option><option value='North Macedonia' >North Macedonia<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Norway' >Norway<\/option><option value='Oman' >Oman<\/option><option value='Pakistan' >Pakistan<\/option><option value='Palau' >Palau<\/option><option value='Palestine, State of' >Palestine, State of<\/option><option value='Panama' >Panama<\/option><option value='Papua New Guinea' >Papua New Guinea<\/option><option value='Paraguay' >Paraguay<\/option><option value='Peru' >Peru<\/option><option value='Philippines' >Philippines<\/option><option value='Pitcairn' >Pitcairn<\/option><option value='Poland' >Poland<\/option><option value='Portugal' >Portugal<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Qatar' >Qatar<\/option><option value='Romania' >Romania<\/option><option value='Russian Federation' >Russian Federation<\/option><option value='Rwanda' >Rwanda<\/option><option value='R\u00e9union' >R\u00e9union<\/option><option value='Saint Barth\u00e9lemy' >Saint Barth\u00e9lemy<\/option><option value='Saint Helena, Ascension and Tristan da Cunha' >Saint Helena, Ascension and Tristan da Cunha<\/option><option value='Saint Kitts and Nevis' >Saint Kitts and Nevis<\/option><option value='Saint Lucia' >Saint Lucia<\/option><option value='Saint Martin' >Saint Martin<\/option><option value='Saint Pierre and Miquelon' >Saint Pierre and Miquelon<\/option><option value='Saint Vincent and the Grenadines' >Saint Vincent and the Grenadines<\/option><option value='Samoa' >Samoa<\/option><option value='San Marino' >San Marino<\/option><option value='Sao Tome and Principe' >Sao Tome and Principe<\/option><option value='Saudi Arabia' >Saudi Arabia<\/option><option value='Senegal' >Senegal<\/option><option value='Serbia' >Serbia<\/option><option value='Seychelles' >Seychelles<\/option><option value='Sierra Leone' >Sierra Leone<\/option><option value='Singapore' >Singapore<\/option><option value='Sint Maarten' >Sint Maarten<\/option><option value='Slovakia' >Slovakia<\/option><option value='Slovenia' >Slovenia<\/option><option value='Solomon Islands' >Solomon Islands<\/option><option value='Somalia' >Somalia<\/option><option value='South Africa' >South Africa<\/option><option value='South Georgia and the South Sandwich Islands' >South Georgia and the South Sandwich Islands<\/option><option value='South Sudan' >South Sudan<\/option><option value='Spain' >Spain<\/option><option value='Sri Lanka' >Sri Lanka<\/option><option value='Sudan' >Sudan<\/option><option value='Suriname' >Suriname<\/option><option value='Svalbard and Jan Mayen' >Svalbard and Jan Mayen<\/option><option value='Sweden' >Sweden<\/option><option value='Switzerland' >Switzerland<\/option><option value='Syria Arab Republic' >Syria Arab Republic<\/option><option value='Taiwan' >Taiwan<\/option><option value='Tajikistan' >Tajikistan<\/option><option value='Tanzania, the United Republic of' >Tanzania, the United Republic of<\/option><option value='Thailand' >Thailand<\/option><option value='Timor-Leste' >Timor-Leste<\/option><option value='Togo' >Togo<\/option><option value='Tokelau' >Tokelau<\/option><option value='Tonga' >Tonga<\/option><option value='Trinidad and Tobago' >Trinidad and Tobago<\/option><option value='Tunisia' >Tunisia<\/option><option value='Turkmenistan' >Turkmenistan<\/option><option value='Turks and Caicos Islands' >Turks and Caicos Islands<\/option><option value='Tuvalu' >Tuvalu<\/option><option value='T\u00fcrkiye' >T\u00fcrkiye<\/option><option value='US Minor Outlying Islands' >US Minor Outlying Islands<\/option><option value='Uganda' >Uganda<\/option><option value='Ukraine' >Ukraine<\/option><option value='United Arab Emirates' >United Arab Emirates<\/option><option value='United Kingdom' >United Kingdom<\/option><option value='United States' selected='selected'>United States<\/option><option value='Uruguay' >Uruguay<\/option><option value='Uzbekistan' >Uzbekistan<\/option><option value='Vanuatu' >Vanuatu<\/option><option value='Venezuela' >Venezuela<\/option><option value='Viet Nam' >Viet Nam<\/option><option value='Virgin Islands, British' >Virgin Islands, British<\/option><option value='Virgin Islands, U.S.' >Virgin Islands, U.S.<\/option><option value='Wallis and Futuna' >Wallis and Futuna<\/option><option value='Western Sahara' >Western Sahara<\/option><option value='Yemen' >Yemen<\/option><option value='Zambia' >Zambia<\/option><option value='Zimbabwe' >Zimbabwe<\/option><option value='\u00c5land Islands' >\u00c5land Islands<\/option><\/select>\n                                        <label for='input_57_12_6' id='input_57_12_6_label' class='gform-field-label gform-field-label--type-sub '>Country<\/label>\n                                    <\/span>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><fieldset id=\"field_57_31\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Credentials<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='gfield_description' id='gfield_description_57_31'>Please check all that apply.<\/div><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_57_31'><div class='gchoice gchoice_57_31_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_31.1' type='checkbox'  value='MD'  id='choice_57_31_1' tabindex='16'  aria-describedby=\"gfield_description_57_31\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_57_31_1' id='label_57_31_1' class='gform-field-label gform-field-label--type-inline'>MD<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_57_31_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_31.2' type='checkbox'  value='DO'  id='choice_57_31_2' tabindex='17'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_57_31_2' id='label_57_31_2' class='gform-field-label gform-field-label--type-inline'>DO<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_57_31_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_31.3' type='checkbox'  value='Resident'  id='choice_57_31_3' tabindex='18'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_57_31_3' id='label_57_31_3' class='gform-field-label gform-field-label--type-inline'>Resident<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_57_31_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_31.4' type='checkbox'  value='Fellow'  id='choice_57_31_4' tabindex='19'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_57_31_4' id='label_57_31_4' class='gform-field-label gform-field-label--type-inline'>Fellow<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_57_31_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_31.5' type='checkbox'  value='Medical Student'  id='choice_57_31_5' tabindex='20'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_57_31_5' id='label_57_31_5' class='gform-field-label gform-field-label--type-inline'>Medical Student<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_57_31_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_31.6' type='checkbox'  value='PA'  id='choice_57_31_6' tabindex='21'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_57_31_6' id='label_57_31_6' class='gform-field-label gform-field-label--type-inline'>PA<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_57_31_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_31.7' type='checkbox'  value='RN'  id='choice_57_31_7' tabindex='22'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_57_31_7' id='label_57_31_7' class='gform-field-label gform-field-label--type-inline'>RN<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_57_31_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_31.8' type='checkbox'  value='NP'  id='choice_57_31_8' tabindex='23'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_57_31_8' id='label_57_31_8' class='gform-field-label gform-field-label--type-inline'>NP<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_57_31_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_31.9' type='checkbox'  value='LPN'  id='choice_57_31_9' tabindex='24'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_57_31_9' id='label_57_31_9' class='gform-field-label gform-field-label--type-inline'>LPN<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_57_31_11'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_31.11' type='checkbox'  value='EMT'  id='choice_57_31_11' tabindex='25'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_57_31_11' id='label_57_31_11' class='gform-field-label gform-field-label--type-inline'>EMT<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_57_31_12'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_31.12' type='checkbox'  value='Other'  id='choice_57_31_12' tabindex='26'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_57_31_12' id='label_57_31_12' class='gform-field-label gform-field-label--type-inline'>Other<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_57_47\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Military Service<\/h3><\/div><div id=\"field_57_45\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_57_45'>Are you an active member of the military?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_45' id='input_57_45' class='large gfield_select' tabindex='27' aria-describedby=\"gfield_description_57_45\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='Yes' >Yes<\/option><option value='No' selected='selected'>No<\/option><\/select><\/div><div class='gfield_description' id='gfield_description_57_45'>Active Military: You can register for the $50\/day rate. Please select Medical Students\/Residents\/Fellows\/EMTs\/Active Military when asked your Registration Category below.<\/div><\/div><div id=\"field_57_46\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_57_46'>If yes, please tell us what branch:<\/label><div class='ginput_container ginput_container_text'><input name='input_46' id='input_57_46' type='text' value='' class='large'   tabindex='28'   aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_57_48\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Organization Information<\/h3><\/div><div id=\"field_57_13\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_57_13'>Hospital\/School\/Company\/Organization Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_13' id='input_57_13' type='text' value='' class='medium'   tabindex='29'  aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_57_14\" class=\"gfield gfield--type-address gfield--input-type-address gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Hospital\/School\/Company\/Organization Location<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_city has_state has_country ginput_container_address gform-grid-row' id='input_57_14' >\n                        <span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_57_14_3_container' >\n                                    <input type='text' name='input_14.3' id='input_57_14_3' value='' tabindex='31'   aria-required='true'    \/>\n                                    <label for='input_57_14_3' id='input_57_14_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_57_14_4_container' >\n                                        <input type='text' name='input_14.4' id='input_57_14_4' value='' tabindex='33'     aria-required='true'    \/>\n                                        <label for='input_57_14_4' id='input_57_14_4_label' class='gform-field-label gform-field-label--type-sub '>State \/ Province \/ Region<\/label>\n                                      <\/span><span class='ginput_right address_country ginput_address_country gform-grid-col' id='input_57_14_6_container' >\n                                        <select name='input_14.6' id='input_57_14_6' tabindex='35'  aria-required='true'    ><option value='' ><\/option><option value='Afghanistan' >Afghanistan<\/option><option value='Albania' >Albania<\/option><option value='Algeria' >Algeria<\/option><option value='American Samoa' >American Samoa<\/option><option value='Andorra' >Andorra<\/option><option value='Angola' >Angola<\/option><option value='Anguilla' >Anguilla<\/option><option value='Antarctica' >Antarctica<\/option><option value='Antigua and Barbuda' >Antigua and Barbuda<\/option><option value='Argentina' >Argentina<\/option><option value='Armenia' >Armenia<\/option><option value='Aruba' >Aruba<\/option><option value='Australia' >Australia<\/option><option value='Austria' >Austria<\/option><option value='Azerbaijan' >Azerbaijan<\/option><option value='Bahamas' >Bahamas<\/option><option value='Bahrain' >Bahrain<\/option><option value='Bangladesh' >Bangladesh<\/option><option value='Barbados' >Barbados<\/option><option value='Belarus' >Belarus<\/option><option value='Belgium' >Belgium<\/option><option value='Belize' >Belize<\/option><option value='Benin' >Benin<\/option><option value='Bermuda' >Bermuda<\/option><option value='Bhutan' >Bhutan<\/option><option value='Bolivia' >Bolivia<\/option><option value='Bonaire, Sint Eustatius and Saba' >Bonaire, Sint Eustatius and Saba<\/option><option value='Bosnia and Herzegovina' >Bosnia and Herzegovina<\/option><option value='Botswana' >Botswana<\/option><option value='Bouvet Island' >Bouvet Island<\/option><option value='Brazil' >Brazil<\/option><option value='British Indian Ocean Territory' >British Indian Ocean Territory<\/option><option value='Brunei Darussalam' >Brunei Darussalam<\/option><option value='Bulgaria' >Bulgaria<\/option><option value='Burkina Faso' >Burkina Faso<\/option><option value='Burundi' >Burundi<\/option><option value='Cabo Verde' >Cabo Verde<\/option><option value='Cambodia' >Cambodia<\/option><option value='Cameroon' >Cameroon<\/option><option value='Canada' >Canada<\/option><option value='Cayman Islands' >Cayman Islands<\/option><option value='Central African Republic' >Central African Republic<\/option><option value='Chad' >Chad<\/option><option value='Chile' >Chile<\/option><option value='China' >China<\/option><option value='Christmas Island' >Christmas Island<\/option><option value='Cocos Islands' >Cocos Islands<\/option><option value='Colombia' >Colombia<\/option><option value='Comoros' >Comoros<\/option><option value='Congo' >Congo<\/option><option value='Congo, Democratic Republic of the' >Congo, Democratic Republic of the<\/option><option value='Cook Islands' >Cook Islands<\/option><option value='Costa Rica' >Costa Rica<\/option><option value='Croatia' >Croatia<\/option><option value='Cuba' >Cuba<\/option><option value='Cura\u00e7ao' >Cura\u00e7ao<\/option><option value='Cyprus' >Cyprus<\/option><option value='Czechia' >Czechia<\/option><option value='C\u00f4te d&#039;Ivoire' >C\u00f4te d&#039;Ivoire<\/option><option value='Denmark' >Denmark<\/option><option value='Djibouti' >Djibouti<\/option><option value='Dominica' >Dominica<\/option><option value='Dominican Republic' >Dominican Republic<\/option><option value='Ecuador' >Ecuador<\/option><option value='Egypt' >Egypt<\/option><option value='El Salvador' >El Salvador<\/option><option value='Equatorial Guinea' >Equatorial Guinea<\/option><option value='Eritrea' >Eritrea<\/option><option value='Estonia' >Estonia<\/option><option value='Eswatini' >Eswatini<\/option><option value='Ethiopia' >Ethiopia<\/option><option value='Falkland Islands' >Falkland Islands<\/option><option value='Faroe Islands' >Faroe Islands<\/option><option value='Fiji' >Fiji<\/option><option value='Finland' >Finland<\/option><option value='France' >France<\/option><option value='French Guiana' >French Guiana<\/option><option value='French Polynesia' >French Polynesia<\/option><option value='French Southern Territories' >French Southern Territories<\/option><option value='Gabon' >Gabon<\/option><option value='Gambia' >Gambia<\/option><option value='Georgia' >Georgia<\/option><option value='Germany' >Germany<\/option><option value='Ghana' >Ghana<\/option><option value='Gibraltar' >Gibraltar<\/option><option value='Greece' >Greece<\/option><option value='Greenland' >Greenland<\/option><option value='Grenada' >Grenada<\/option><option value='Guadeloupe' >Guadeloupe<\/option><option value='Guam' >Guam<\/option><option value='Guatemala' >Guatemala<\/option><option value='Guernsey' >Guernsey<\/option><option value='Guinea' >Guinea<\/option><option value='Guinea-Bissau' >Guinea-Bissau<\/option><option value='Guyana' >Guyana<\/option><option value='Haiti' >Haiti<\/option><option value='Heard Island and McDonald Islands' >Heard Island and McDonald Islands<\/option><option value='Holy See' >Holy See<\/option><option value='Honduras' >Honduras<\/option><option value='Hong Kong' >Hong Kong<\/option><option value='Hungary' >Hungary<\/option><option value='Iceland' >Iceland<\/option><option value='India' >India<\/option><option value='Indonesia' >Indonesia<\/option><option value='Iran' >Iran<\/option><option value='Iraq' >Iraq<\/option><option value='Ireland' >Ireland<\/option><option value='Isle of Man' >Isle of Man<\/option><option value='Israel' >Israel<\/option><option value='Italy' >Italy<\/option><option value='Jamaica' >Jamaica<\/option><option value='Japan' >Japan<\/option><option value='Jersey' >Jersey<\/option><option value='Jordan' >Jordan<\/option><option value='Kazakhstan' >Kazakhstan<\/option><option value='Kenya' >Kenya<\/option><option value='Kiribati' >Kiribati<\/option><option value='Korea, Democratic People&#039;s Republic of' >Korea, Democratic People&#039;s Republic of<\/option><option value='Korea, Republic of' >Korea, Republic of<\/option><option value='Kuwait' >Kuwait<\/option><option value='Kyrgyzstan' >Kyrgyzstan<\/option><option value='Lao People&#039;s Democratic Republic' >Lao People&#039;s Democratic Republic<\/option><option value='Latvia' >Latvia<\/option><option value='Lebanon' >Lebanon<\/option><option value='Lesotho' >Lesotho<\/option><option value='Liberia' >Liberia<\/option><option value='Libya' >Libya<\/option><option value='Liechtenstein' >Liechtenstein<\/option><option value='Lithuania' >Lithuania<\/option><option value='Luxembourg' >Luxembourg<\/option><option value='Macao' >Macao<\/option><option value='Madagascar' >Madagascar<\/option><option value='Malawi' >Malawi<\/option><option value='Malaysia' >Malaysia<\/option><option value='Maldives' >Maldives<\/option><option value='Mali' >Mali<\/option><option value='Malta' >Malta<\/option><option value='Marshall Islands' >Marshall Islands<\/option><option value='Martinique' >Martinique<\/option><option value='Mauritania' >Mauritania<\/option><option value='Mauritius' >Mauritius<\/option><option value='Mayotte' >Mayotte<\/option><option value='Mexico' >Mexico<\/option><option value='Micronesia' >Micronesia<\/option><option value='Moldova' >Moldova<\/option><option value='Monaco' >Monaco<\/option><option value='Mongolia' >Mongolia<\/option><option value='Montenegro' >Montenegro<\/option><option value='Montserrat' >Montserrat<\/option><option value='Morocco' >Morocco<\/option><option value='Mozambique' >Mozambique<\/option><option value='Myanmar' >Myanmar<\/option><option value='Namibia' >Namibia<\/option><option value='Nauru' >Nauru<\/option><option value='Nepal' >Nepal<\/option><option value='Netherlands' >Netherlands<\/option><option value='New Caledonia' >New Caledonia<\/option><option value='New Zealand' >New Zealand<\/option><option value='Nicaragua' >Nicaragua<\/option><option value='Niger' >Niger<\/option><option value='Nigeria' >Nigeria<\/option><option value='Niue' >Niue<\/option><option value='Norfolk Island' >Norfolk Island<\/option><option value='North Macedonia' >North Macedonia<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Norway' >Norway<\/option><option value='Oman' >Oman<\/option><option value='Pakistan' >Pakistan<\/option><option value='Palau' >Palau<\/option><option value='Palestine, State of' >Palestine, State of<\/option><option value='Panama' >Panama<\/option><option value='Papua New Guinea' >Papua New Guinea<\/option><option value='Paraguay' >Paraguay<\/option><option value='Peru' >Peru<\/option><option value='Philippines' >Philippines<\/option><option value='Pitcairn' >Pitcairn<\/option><option value='Poland' >Poland<\/option><option value='Portugal' >Portugal<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Qatar' >Qatar<\/option><option value='Romania' >Romania<\/option><option value='Russian Federation' >Russian Federation<\/option><option value='Rwanda' >Rwanda<\/option><option value='R\u00e9union' >R\u00e9union<\/option><option value='Saint Barth\u00e9lemy' >Saint Barth\u00e9lemy<\/option><option value='Saint Helena, Ascension and Tristan da Cunha' >Saint Helena, Ascension and Tristan da Cunha<\/option><option value='Saint Kitts and Nevis' >Saint Kitts and Nevis<\/option><option value='Saint Lucia' >Saint Lucia<\/option><option value='Saint Martin' >Saint Martin<\/option><option value='Saint Pierre and Miquelon' >Saint Pierre and Miquelon<\/option><option value='Saint Vincent and the Grenadines' >Saint Vincent and the Grenadines<\/option><option value='Samoa' >Samoa<\/option><option value='San Marino' >San Marino<\/option><option value='Sao Tome and Principe' >Sao Tome and Principe<\/option><option value='Saudi Arabia' >Saudi Arabia<\/option><option value='Senegal' >Senegal<\/option><option value='Serbia' >Serbia<\/option><option value='Seychelles' >Seychelles<\/option><option value='Sierra Leone' >Sierra Leone<\/option><option value='Singapore' >Singapore<\/option><option value='Sint Maarten' >Sint Maarten<\/option><option value='Slovakia' >Slovakia<\/option><option value='Slovenia' >Slovenia<\/option><option value='Solomon Islands' >Solomon Islands<\/option><option value='Somalia' >Somalia<\/option><option value='South Africa' >South Africa<\/option><option value='South Georgia and the South Sandwich Islands' >South Georgia and the South Sandwich Islands<\/option><option value='South Sudan' >South Sudan<\/option><option value='Spain' >Spain<\/option><option value='Sri Lanka' >Sri Lanka<\/option><option value='Sudan' >Sudan<\/option><option value='Suriname' >Suriname<\/option><option value='Svalbard and Jan Mayen' >Svalbard and Jan Mayen<\/option><option value='Sweden' >Sweden<\/option><option value='Switzerland' >Switzerland<\/option><option value='Syria Arab Republic' >Syria Arab Republic<\/option><option value='Taiwan' >Taiwan<\/option><option value='Tajikistan' >Tajikistan<\/option><option value='Tanzania, the United Republic of' >Tanzania, the United Republic of<\/option><option value='Thailand' >Thailand<\/option><option value='Timor-Leste' >Timor-Leste<\/option><option value='Togo' >Togo<\/option><option value='Tokelau' >Tokelau<\/option><option value='Tonga' >Tonga<\/option><option value='Trinidad and Tobago' >Trinidad and Tobago<\/option><option value='Tunisia' >Tunisia<\/option><option value='Turkmenistan' >Turkmenistan<\/option><option value='Turks and Caicos Islands' >Turks and Caicos Islands<\/option><option value='Tuvalu' >Tuvalu<\/option><option value='T\u00fcrkiye' >T\u00fcrkiye<\/option><option value='US Minor Outlying Islands' >US Minor Outlying Islands<\/option><option value='Uganda' >Uganda<\/option><option value='Ukraine' >Ukraine<\/option><option value='United Arab Emirates' >United Arab Emirates<\/option><option value='United Kingdom' >United Kingdom<\/option><option value='United States' selected='selected'>United States<\/option><option value='Uruguay' >Uruguay<\/option><option value='Uzbekistan' >Uzbekistan<\/option><option value='Vanuatu' >Vanuatu<\/option><option value='Venezuela' >Venezuela<\/option><option value='Viet Nam' >Viet Nam<\/option><option value='Virgin Islands, British' >Virgin Islands, British<\/option><option value='Virgin Islands, U.S.' >Virgin Islands, U.S.<\/option><option value='Wallis and Futuna' >Wallis and Futuna<\/option><option value='Western Sahara' >Western Sahara<\/option><option value='Yemen' >Yemen<\/option><option value='Zambia' >Zambia<\/option><option value='Zimbabwe' >Zimbabwe<\/option><option value='\u00c5land Islands' >\u00c5land Islands<\/option><\/select>\n                                        <label for='input_57_14_6' id='input_57_14_6_label' class='gform-field-label gform-field-label--type-sub '>Country<\/label>\n                                    <\/span>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_57_49\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Registration Information<\/h3><\/div><div id=\"field_57_4\" class=\"gfield gfield--type-select gfield--input-type-select gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_57_4'>Registration Category<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_57_4'>Required to determine registration pricing. <\/div><div class='ginput_container ginput_container_select'><select name='input_4' id='input_57_4' class='medium gfield_select' tabindex='36' aria-describedby=\"gfield_description_57_4\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='Physician' selected='selected'>Physician<\/option><option value='AHP' >PA, NP, RN, CRNA<\/option><option value='Student' >Medical Students\/Residents\/Fellows\/EMTs\/Active Military<\/option><\/select><\/div><\/div><div id=\"field_57_73\" class=\"gfield gfield--type-product gfield--input-type-singleproduct gfield--width-full gfield_price gfield_price_57_73 gfield_product_57_73 field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' for='input_57_73_1'>Physician Conference Registration<\/label><div class='ginput_container ginput_container_singleproduct'>\n\t\t\t\t\t<input type='hidden' name='input_73.1' value='Physician Conference Registration' class='gform_hidden' \/>\n\t\t\t\t\t<div id='ginput_product_price_57_73' class='ginput_product_price_wrapper'>\n\t\t\t\t\t\t<label for='ginput_base_price_57_73' class='gform-field-label gform-field-label--type-sub-large ginput_product_price_label'>Price:<\/label>\n\t\t\t\t\t\t<input type='text' readonly class='ginput_product_price gform-text-input-reset' name='input_73.2' id='ginput_base_price_57_73' value='$400.00' aria-label='Physician Conference Registration Price'  \/>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<input type='hidden' name='input_73.3' value='1' class='ginput_quantity_57_73 gform_hidden' \/>\n\t\t\t\t<\/div><\/div><div id=\"field_57_71\" class=\"gfield gfield--type-product gfield--input-type-singleproduct gfield--width-full gfield_price gfield_price_57_71 gfield_product_57_71 field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' for='input_57_71_1'>PA, NP, RN, CRNA Conference Registration<\/label><div class='ginput_container ginput_container_singleproduct'>\n\t\t\t\t\t<input type='hidden' name='input_71.1' value='PA, NP, RN, CRNA Conference Registration' class='gform_hidden' \/>\n\t\t\t\t\t<div id='ginput_product_price_57_71' class='ginput_product_price_wrapper'>\n\t\t\t\t\t\t<label for='ginput_base_price_57_71' class='gform-field-label gform-field-label--type-sub-large ginput_product_price_label'>Price:<\/label>\n\t\t\t\t\t\t<input type='text' readonly class='ginput_product_price gform-text-input-reset' name='input_71.2' id='ginput_base_price_57_71' value='$200.00' aria-label='PA, NP, RN, CRNA Conference Registration Price'  \/>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<input type='hidden' name='input_71.3' value='1' class='ginput_quantity_57_71 gform_hidden' \/>\n\t\t\t\t<\/div><\/div><div id=\"field_57_74\" class=\"gfield gfield--type-product gfield--input-type-singleproduct gfield--width-full gfield_price gfield_price_57_74 gfield_product_57_74 field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' for='input_57_74_1'>Medical Student\/Resident\/Fellow\/EMTs\/Active Military Conference Registration<\/label><div class='ginput_container ginput_container_singleproduct'>\n\t\t\t\t\t<input type='hidden' name='input_74.1' value='Medical Student\/Resident\/Fellow\/EMTs\/Active Military Conference Registration' class='gform_hidden' \/>\n\t\t\t\t\t<div id='ginput_product_price_57_74' class='ginput_product_price_wrapper'>\n\t\t\t\t\t\t<label for='ginput_base_price_57_74' class='gform-field-label gform-field-label--type-sub-large ginput_product_price_label'>Price:<\/label>\n\t\t\t\t\t\t<input type='text' readonly class='ginput_product_price gform-text-input-reset' name='input_74.2' id='ginput_base_price_57_74' value='$50.00' aria-label='Medical Student\/Resident\/Fellow\/EMTs\/Active Military Conference Registration Price'  \/>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<input type='hidden' name='input_74.3' value='1' class='ginput_quantity_57_74 gform_hidden' \/>\n\t\t\t\t<\/div><\/div><div id=\"field_57_37\" class=\"gfield gfield--type-select gfield--input-type-select field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"This field is hidden when viewing the form\"><\/i><span>This field is hidden when viewing the form<\/span><\/div><label class='gfield_label gform-field-label' for='input_57_37'>Conference Backend<\/label><div class='ginput_container ginput_container_select'><select name='input_37' id='input_57_37' class='medium gfield_select' tabindex='37'    aria-invalid=\"false\" ><option value='12573' selected='selected'>Conference Backend<\/option><\/select><\/div><\/div><fieldset id=\"field_57_44\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datefield gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"This field is hidden when viewing the form\"><\/i><span>This field is hidden when viewing the form<\/span><\/div><legend class='gfield_label gform-field-label gfield_label_before_complex' >Date<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div id='input_57_44' class='ginput_container ginput_complex gform-grid-row'><div class='gfield_date_month ginput_container ginput_container_date gform-grid-col' id='input_57_44_1_container'>\n                                            <input type='number' maxlength='2' name='input_44[]' id='input_57_44_1' value='10' tabindex='38'  aria-required='true'   placeholder='MM' min='1' max='12' step='1'\/>\n                                            <label for='input_57_44_1' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Month<\/label>\n                                        <\/div><div class='gfield_date_day ginput_container ginput_container_date gform-grid-col' id='input_57_44_2_container'>\n                                            <input type='number' maxlength='2' name='input_44[]' id='input_57_44_2' value='31' tabindex='39'  aria-required='true'   placeholder='DD' min='1' max='31' step='1'\/>\n                                            <label for='input_57_44_2' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Day<\/label>\n                                        <\/div><div class='gfield_date_year ginput_container ginput_container_date gform-grid-col' id='input_57_44_3_container'>\n                                            <input type='number' maxlength='4' name='input_44[]' id='input_57_44_3' value='2025' tabindex='40'  aria-required='true'   placeholder='YYYY' min='1920' max='2027' step='1'\/>\n                                            <label for='input_57_44_3' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Year<\/label>\n                                       <\/div>\n                                   <\/div><\/fieldset><div id=\"field_57_55\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><\/div><fieldset id=\"field_57_32\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >How did you  hear about this conference?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='gfield_description' id='gfield_description_57_32'>Please check all that apply.<\/div><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_57_32'><div class='gchoice gchoice_57_32_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_32.1' type='checkbox'  value='Email'  id='choice_57_32_1' tabindex='41'  aria-describedby=\"gfield_description_57_32\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_57_32_1' id='label_57_32_1' class='gform-field-label gform-field-label--type-inline'>Email<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_57_32_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_32.2' type='checkbox'  value='Internet search'  id='choice_57_32_2' tabindex='42'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_57_32_2' id='label_57_32_2' class='gform-field-label gform-field-label--type-inline'>Internet search<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_57_32_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_32.3' type='checkbox'  value='Twitter'  id='choice_57_32_3' tabindex='43'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_57_32_3' id='label_57_32_3' class='gform-field-label gform-field-label--type-inline'>Twitter<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_57_32_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_32.4' type='checkbox'  value='Podcast'  id='choice_57_32_4' tabindex='44'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_57_32_4' id='label_57_32_4' class='gform-field-label gform-field-label--type-inline'>Podcast<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_57_32_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_32.5' type='checkbox'  value='Referral'  id='choice_57_32_5' tabindex='45'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_57_32_5' id='label_57_32_5' class='gform-field-label gform-field-label--type-inline'>Referral<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_57_32_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_32.6' type='checkbox'  value='I have attended Conference in the past'  id='choice_57_32_6' tabindex='46'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_57_32_6' id='label_57_32_6' class='gform-field-label gform-field-label--type-inline'>I have attended Conference in the past<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_57_32_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_32.7' type='checkbox'  value='Other'  id='choice_57_32_7' tabindex='47'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_57_32_7' id='label_57_32_7' class='gform-field-label gform-field-label--type-inline'>Other<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_57_30\" class=\"gfield gfield--type-select gfield--input-type-select gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_57_30'>Would you like to receive emails about other University of Maryland Department of Emergency Medicine education events?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_30' id='input_57_30' class='medium gfield_select' tabindex='48'   aria-required=\"true\" aria-invalid=\"false\" ><option value='Yes, please add me to the mailing list.' >Yes, please add me to the mailing list.<\/option><option value='No, I would only like to receive emails pertaining to The Crashing Patient Conference.' >No, I would only like to receive emails pertaining to The Crashing Patient Conference.<\/option><\/select><\/div><\/div><div id=\"field_57_50\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Payment Information<\/h3><div class='gsection_description' id='gfield_description_57_50'>International Participants: We have noticed that some people are having trouble with PayPal accepting payment. To enable international transactions on your Debit or Credit Card, Login to Netbanking > Cards > Credit\/Debit Cards > Request > International Enable.  For Debit cards \u2013Login to Netbanking > Cards > Credit\/Debit Cards > Request > International Enable. Paypal accepts payments from 200 countries (https:\/\/www.paypal.com\/us\/webapps\/mpp\/country-worldwide) if your country is not on the list please email dlucadamo@som.umaryland.edu to get additional help.\n<\/div><\/div><div id=\"field_57_22\" class=\"gfield gfield--type-coupon gfield--input-type-coupon gfield--width-full field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='gf_coupon_code_57'>Coupon<\/label><div class='ginput_container' id='gf_coupons_container_57'><div class='ginput_container_coupon'><input id='gf_coupon_code_57' class='gf_coupon_code' onkeyup='DisableApplyButton(57);' onchange='DisableApplyButton(57);' onpaste='setTimeout(function(){DisableApplyButton(57);}, 50);' type='text'    tabindex='49'\/><input type='button' disabled='disabled' onclick='ApplyCouponCode(57);' value='Apply' id='gf_coupon_button' class='button'  tabindex='50'\/> <img style='display:none;' id='gf_coupon_spinner' src='https:\/\/cms.umem.org\/wp-content\/plugins\/gravityformscoupons\/images\/spinner.gif' alt='please wait'\/><\/div><div id='gf_coupon_info'><\/div><input type='hidden' id='gf_coupon_codes_57' name='input_22' value=''  \/><input type='hidden' id='gf_total_no_discount_57'\/><input type='hidden' id='gf_coupons_57' name='gf_coupons_57' value='' \/><\/div><\/div><div id=\"field_57_75\" class=\"gfield gfield--type-total gfield--input-type-total gfield--width-full gfield_price gfield_price_57_ gfield_total gfield_total_57_ field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  aria-atomic=\"true\" aria-live=\"polite\" ><label class='gfield_label gform-field-label' for='input_57_75'>Total<\/label><div class='ginput_container ginput_container_total'>\n\t\t\t\t\t\t\t<input type='text' readonly name='input_75' id='input_57_75' value='$0.00' class='gform-text-input-reset ginput_total ginput_total_57' \/>\n\t\t\t\t\t\t<\/div><\/div><div id=\"field_57_59\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"This field is hidden when viewing the form\"><\/i><span>This field is hidden when viewing the form<\/span><\/div><label class='gfield_label gform-field-label' for='input_57_59'>Early Bird Backend<\/label><div class='ginput_container ginput_container_select'><select name='input_59' id='input_57_59' class='medium gfield_select' tabindex='51'    aria-invalid=\"false\" ><option value='12574' selected='selected'>Early Bird<\/option><\/select><\/div><\/div><div id=\"field_57_43\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"This field is hidden when viewing the form\"><\/i><span>This field is hidden when viewing the form<\/span><\/div><label class='gfield_label gform-field-label' for='input_57_43'>User Logged in? (hidden)<\/label><div class='ginput_container ginput_container_text'><input name='input_43' id='input_57_43' type='text' value='' class='large'   tabindex='52'   aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_57_27\" class=\"gfield gfield--type-password gfield--input-type-password gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Password<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='gfield_description' id='gfield_description_57_27'>Set a password to access the online portal<\/div><div class='ginput_complex ginput_container ginput_container_password gform-grid-row' id='input_57_27_container'>\n\t\t\t\t\t\t<span id='input_57_27_1_container' class='ginput_password ginput_left gform-grid-col gform-grid-col--size-auto'>\n\t\t\t\t\t\t\t<span class='password_input_container'>\n\t\t\t\t\t\t\t<input type='password' name='input_27' id='input_57_27'   aria-describedby=\"gfield_description_57_27\" value='' tabindex='53'  aria-required=\"true\" aria-invalid=\"false\" \/>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t<label for='input_57_27' class='gform-field-label gform-field-label--type-sub '>Enter Password<\/label>\n\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t<span id='input_57_27_2_container' class='ginput_password ginput_right gform-grid-col gform-grid-col--size-auto'>\n\t\t\t\t\t\t\t<span class='password_input_container'>\n\t\t\t\t\t\t\t<input type='password' name='input_27_2' id='input_57_27_2'   value='' tabindex='54'  aria-required=\"true\" aria-invalid=\"false\" \/>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t<label for='input_57_27_2' class='gform-field-label gform-field-label--type-sub '>Confirm Password<\/label>\n\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t<div class='gf_clear gf_clear_complex'><\/div>\n\t\t\t\t\t<\/div><\/fieldset><div id=\"field_57_61\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Billing Information<\/h3><\/div><div id=\"field_57_65\" class=\"gfield gfield--type-total gfield--input-type-total gfield--width-full gfield_price gfield_price_57_ gfield_total gfield_total_57_ field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  aria-atomic=\"true\" aria-live=\"polite\" ><label class='gfield_label gform-field-label' for='input_57_65'>Total<\/label><div class='ginput_container ginput_container_total'>\n\t\t\t\t\t\t\t<input type='text' readonly name='input_65' id='input_57_65' value='$0.00' class='gform-text-input-reset ginput_total ginput_total_57' \/>\n\t\t\t\t\t\t<\/div><div class='gfield_description' id='gfield_description_57_65'>Total to be charged to your account<\/div><\/div><fieldset id=\"field_57_60\" class=\"gfield gfield--type-address gfield--input-type-address gfield--width-full field_sublabel_above gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Billing Address<\/legend><div class='gfield_description' id='gfield_description_57_60'>This is the address listed on record for your credit card.<\/div>    <div id='input_57_60_copy_values_option_container' class='copy_values_option_container' >\n                                        <input type='checkbox' id='input_57_60_copy_values_activated' class='copy_values_activated' value='1' data-source_field_id='12' name='input_60_copy_values_activated'  \/>\n                                        <label for='input_57_60_copy_values_activated' id='input_57_60_copy_values_option_label' class='copy_values_option_label inline gform-field-label gform-field-label--type-inline'>Same as Address Listed Above<\/label>\n                                    <\/div>\n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip has_country ginput_container_address gform-grid-row' id='input_57_60' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_57_60_1_container' >\n                                        <label for='input_57_60_1' id='input_57_60_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                        <input type='text' name='input_60.1' id='input_57_60_1' value='' tabindex='55'   aria-required='false'    \/>\n                                   <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_57_60_2_container' >\n                                        <label for='input_57_60_2' id='input_57_60_2_label' class='gform-field-label gform-field-label--type-sub '>Address Line 2<\/label>\n                                        <input type='text' name='input_60.2' id='input_57_60_2' value='' tabindex='56'    aria-required='false'   \/>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_57_60_3_container' >\n                                    <label for='input_57_60_3' id='input_57_60_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                    <input type='text' name='input_60.3' id='input_57_60_3' value='' tabindex='57'   aria-required='false'    \/>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_57_60_4_container' >\n                                        <label for='input_57_60_4' id='input_57_60_4_label' class='gform-field-label gform-field-label--type-sub '>State \/ Province \/ Region<\/label>\n                                        <input type='text' name='input_60.4' id='input_57_60_4' value='' tabindex='59'     aria-required='false'    \/>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_57_60_5_container' >\n                                    <label for='input_57_60_5' id='input_57_60_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP \/ Postal Code<\/label>\n                                    <input type='text' name='input_60.5' id='input_57_60_5' value='' tabindex='60'   aria-required='false'    \/>\n                                <\/span><span class='ginput_right address_country ginput_address_country gform-grid-col' id='input_57_60_6_container' >\n                                        <label for='input_57_60_6' id='input_57_60_6_label' class='gform-field-label gform-field-label--type-sub '>Country<\/label>\n                                        <select name='input_60.6' id='input_57_60_6' tabindex='61'  aria-required='false'    ><option value='' ><\/option><option value='Afghanistan' >Afghanistan<\/option><option value='Albania' >Albania<\/option><option value='Algeria' >Algeria<\/option><option value='American Samoa' >American Samoa<\/option><option value='Andorra' >Andorra<\/option><option value='Angola' >Angola<\/option><option value='Anguilla' >Anguilla<\/option><option value='Antarctica' >Antarctica<\/option><option value='Antigua and Barbuda' >Antigua and Barbuda<\/option><option value='Argentina' >Argentina<\/option><option value='Armenia' >Armenia<\/option><option value='Aruba' >Aruba<\/option><option value='Australia' >Australia<\/option><option value='Austria' >Austria<\/option><option value='Azerbaijan' >Azerbaijan<\/option><option value='Bahamas' >Bahamas<\/option><option value='Bahrain' >Bahrain<\/option><option value='Bangladesh' >Bangladesh<\/option><option value='Barbados' >Barbados<\/option><option value='Belarus' >Belarus<\/option><option value='Belgium' >Belgium<\/option><option value='Belize' >Belize<\/option><option value='Benin' >Benin<\/option><option value='Bermuda' >Bermuda<\/option><option value='Bhutan' >Bhutan<\/option><option value='Bolivia' >Bolivia<\/option><option value='Bonaire, Sint Eustatius and Saba' >Bonaire, Sint Eustatius and Saba<\/option><option value='Bosnia and Herzegovina' >Bosnia and Herzegovina<\/option><option value='Botswana' >Botswana<\/option><option value='Bouvet Island' >Bouvet Island<\/option><option value='Brazil' >Brazil<\/option><option value='British Indian Ocean Territory' >British Indian Ocean Territory<\/option><option value='Brunei Darussalam' >Brunei Darussalam<\/option><option value='Bulgaria' >Bulgaria<\/option><option value='Burkina Faso' >Burkina Faso<\/option><option value='Burundi' >Burundi<\/option><option value='Cabo Verde' >Cabo Verde<\/option><option value='Cambodia' >Cambodia<\/option><option value='Cameroon' >Cameroon<\/option><option value='Canada' >Canada<\/option><option value='Cayman Islands' >Cayman Islands<\/option><option value='Central African Republic' >Central African Republic<\/option><option value='Chad' >Chad<\/option><option value='Chile' >Chile<\/option><option value='China' >China<\/option><option value='Christmas Island' >Christmas Island<\/option><option value='Cocos Islands' >Cocos Islands<\/option><option value='Colombia' >Colombia<\/option><option value='Comoros' >Comoros<\/option><option value='Congo' >Congo<\/option><option value='Congo, Democratic Republic of the' >Congo, Democratic Republic of the<\/option><option value='Cook Islands' >Cook Islands<\/option><option value='Costa Rica' >Costa Rica<\/option><option value='Croatia' >Croatia<\/option><option value='Cuba' >Cuba<\/option><option value='Cura\u00e7ao' >Cura\u00e7ao<\/option><option value='Cyprus' >Cyprus<\/option><option value='Czechia' >Czechia<\/option><option value='C\u00f4te d&#039;Ivoire' >C\u00f4te d&#039;Ivoire<\/option><option value='Denmark' >Denmark<\/option><option value='Djibouti' >Djibouti<\/option><option value='Dominica' >Dominica<\/option><option value='Dominican Republic' >Dominican Republic<\/option><option value='Ecuador' >Ecuador<\/option><option value='Egypt' >Egypt<\/option><option value='El Salvador' >El Salvador<\/option><option value='Equatorial Guinea' >Equatorial Guinea<\/option><option value='Eritrea' >Eritrea<\/option><option value='Estonia' >Estonia<\/option><option value='Eswatini' >Eswatini<\/option><option value='Ethiopia' >Ethiopia<\/option><option value='Falkland Islands' >Falkland Islands<\/option><option value='Faroe Islands' >Faroe Islands<\/option><option value='Fiji' >Fiji<\/option><option value='Finland' >Finland<\/option><option value='France' >France<\/option><option value='French Guiana' >French Guiana<\/option><option value='French Polynesia' >French Polynesia<\/option><option value='French Southern Territories' >French Southern Territories<\/option><option value='Gabon' >Gabon<\/option><option value='Gambia' >Gambia<\/option><option value='Georgia' >Georgia<\/option><option value='Germany' >Germany<\/option><option value='Ghana' >Ghana<\/option><option value='Gibraltar' >Gibraltar<\/option><option value='Greece' >Greece<\/option><option value='Greenland' >Greenland<\/option><option value='Grenada' >Grenada<\/option><option value='Guadeloupe' >Guadeloupe<\/option><option value='Guam' >Guam<\/option><option value='Guatemala' >Guatemala<\/option><option value='Guernsey' >Guernsey<\/option><option value='Guinea' >Guinea<\/option><option value='Guinea-Bissau' >Guinea-Bissau<\/option><option value='Guyana' >Guyana<\/option><option value='Haiti' >Haiti<\/option><option value='Heard Island and McDonald Islands' >Heard Island and McDonald Islands<\/option><option value='Holy See' >Holy See<\/option><option value='Honduras' >Honduras<\/option><option value='Hong Kong' >Hong Kong<\/option><option value='Hungary' >Hungary<\/option><option value='Iceland' >Iceland<\/option><option value='India' >India<\/option><option value='Indonesia' >Indonesia<\/option><option value='Iran' >Iran<\/option><option value='Iraq' >Iraq<\/option><option value='Ireland' >Ireland<\/option><option value='Isle of Man' >Isle of Man<\/option><option value='Israel' >Israel<\/option><option value='Italy' >Italy<\/option><option value='Jamaica' >Jamaica<\/option><option value='Japan' >Japan<\/option><option value='Jersey' >Jersey<\/option><option value='Jordan' >Jordan<\/option><option value='Kazakhstan' >Kazakhstan<\/option><option value='Kenya' >Kenya<\/option><option value='Kiribati' >Kiribati<\/option><option value='Korea, Democratic People&#039;s Republic of' >Korea, Democratic People&#039;s Republic of<\/option><option value='Korea, Republic of' >Korea, Republic of<\/option><option value='Kuwait' >Kuwait<\/option><option value='Kyrgyzstan' >Kyrgyzstan<\/option><option value='Lao People&#039;s Democratic Republic' >Lao People&#039;s Democratic Republic<\/option><option value='Latvia' >Latvia<\/option><option value='Lebanon' >Lebanon<\/option><option value='Lesotho' >Lesotho<\/option><option value='Liberia' >Liberia<\/option><option value='Libya' >Libya<\/option><option value='Liechtenstein' >Liechtenstein<\/option><option value='Lithuania' >Lithuania<\/option><option value='Luxembourg' >Luxembourg<\/option><option value='Macao' >Macao<\/option><option value='Madagascar' >Madagascar<\/option><option value='Malawi' >Malawi<\/option><option value='Malaysia' >Malaysia<\/option><option value='Maldives' >Maldives<\/option><option value='Mali' >Mali<\/option><option value='Malta' >Malta<\/option><option value='Marshall Islands' >Marshall Islands<\/option><option value='Martinique' >Martinique<\/option><option value='Mauritania' >Mauritania<\/option><option value='Mauritius' >Mauritius<\/option><option value='Mayotte' >Mayotte<\/option><option value='Mexico' >Mexico<\/option><option value='Micronesia' >Micronesia<\/option><option value='Moldova' >Moldova<\/option><option value='Monaco' >Monaco<\/option><option value='Mongolia' >Mongolia<\/option><option value='Montenegro' >Montenegro<\/option><option value='Montserrat' >Montserrat<\/option><option value='Morocco' >Morocco<\/option><option value='Mozambique' >Mozambique<\/option><option value='Myanmar' >Myanmar<\/option><option value='Namibia' >Namibia<\/option><option value='Nauru' >Nauru<\/option><option value='Nepal' >Nepal<\/option><option value='Netherlands' >Netherlands<\/option><option value='New Caledonia' >New Caledonia<\/option><option value='New Zealand' >New Zealand<\/option><option value='Nicaragua' >Nicaragua<\/option><option value='Niger' >Niger<\/option><option value='Nigeria' >Nigeria<\/option><option value='Niue' >Niue<\/option><option value='Norfolk Island' >Norfolk Island<\/option><option value='North Macedonia' >North Macedonia<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Norway' >Norway<\/option><option value='Oman' >Oman<\/option><option value='Pakistan' >Pakistan<\/option><option value='Palau' >Palau<\/option><option value='Palestine, State of' >Palestine, State of<\/option><option value='Panama' >Panama<\/option><option value='Papua New Guinea' >Papua New Guinea<\/option><option value='Paraguay' >Paraguay<\/option><option value='Peru' >Peru<\/option><option value='Philippines' >Philippines<\/option><option value='Pitcairn' >Pitcairn<\/option><option value='Poland' >Poland<\/option><option value='Portugal' >Portugal<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Qatar' >Qatar<\/option><option value='Romania' >Romania<\/option><option value='Russian Federation' >Russian Federation<\/option><option value='Rwanda' >Rwanda<\/option><option value='R\u00e9union' >R\u00e9union<\/option><option value='Saint Barth\u00e9lemy' >Saint Barth\u00e9lemy<\/option><option value='Saint Helena, Ascension and Tristan da Cunha' >Saint Helena, Ascension and Tristan da Cunha<\/option><option value='Saint Kitts and Nevis' >Saint Kitts and Nevis<\/option><option value='Saint Lucia' >Saint Lucia<\/option><option value='Saint Martin' >Saint Martin<\/option><option value='Saint Pierre and Miquelon' >Saint Pierre and Miquelon<\/option><option value='Saint Vincent and the Grenadines' >Saint Vincent and the Grenadines<\/option><option value='Samoa' >Samoa<\/option><option value='San Marino' >San Marino<\/option><option value='Sao Tome and Principe' >Sao Tome and Principe<\/option><option value='Saudi Arabia' >Saudi Arabia<\/option><option value='Senegal' >Senegal<\/option><option value='Serbia' >Serbia<\/option><option value='Seychelles' >Seychelles<\/option><option value='Sierra Leone' >Sierra Leone<\/option><option value='Singapore' >Singapore<\/option><option value='Sint Maarten' >Sint Maarten<\/option><option value='Slovakia' >Slovakia<\/option><option value='Slovenia' >Slovenia<\/option><option value='Solomon Islands' >Solomon Islands<\/option><option value='Somalia' >Somalia<\/option><option value='South Africa' >South Africa<\/option><option value='South Georgia and the South Sandwich Islands' >South Georgia and the South Sandwich Islands<\/option><option value='South Sudan' >South Sudan<\/option><option value='Spain' >Spain<\/option><option value='Sri Lanka' >Sri Lanka<\/option><option value='Sudan' >Sudan<\/option><option value='Suriname' >Suriname<\/option><option value='Svalbard and Jan Mayen' >Svalbard and Jan Mayen<\/option><option value='Sweden' >Sweden<\/option><option value='Switzerland' >Switzerland<\/option><option value='Syria Arab Republic' >Syria Arab Republic<\/option><option value='Taiwan' >Taiwan<\/option><option value='Tajikistan' >Tajikistan<\/option><option value='Tanzania, the United Republic of' >Tanzania, the United Republic of<\/option><option value='Thailand' >Thailand<\/option><option value='Timor-Leste' >Timor-Leste<\/option><option value='Togo' >Togo<\/option><option value='Tokelau' >Tokelau<\/option><option value='Tonga' >Tonga<\/option><option value='Trinidad and Tobago' >Trinidad and Tobago<\/option><option value='Tunisia' >Tunisia<\/option><option value='Turkmenistan' >Turkmenistan<\/option><option value='Turks and Caicos Islands' >Turks and Caicos Islands<\/option><option value='Tuvalu' >Tuvalu<\/option><option value='T\u00fcrkiye' >T\u00fcrkiye<\/option><option value='US Minor Outlying Islands' >US Minor Outlying Islands<\/option><option value='Uganda' >Uganda<\/option><option value='Ukraine' >Ukraine<\/option><option value='United Arab Emirates' >United Arab Emirates<\/option><option value='United Kingdom' >United Kingdom<\/option><option value='United States' selected='selected'>United States<\/option><option value='Uruguay' >Uruguay<\/option><option value='Uzbekistan' 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*\/\n<\/script>\n<\/div><\/div><\/div><div id=\"x-section-2\" class=\"x-section dark-section\" style=\"margin: 0px;padding: 5px 0px 50px; background-color: transparent;\" ><div id=\"\" class=\"x-container max width\" style=\"margin: 0px auto;padding: 0px;\" ><div  class=\"x-column x-sm x-1-1\" style=\"padding: 0px;\" ><div id=\"\" class=\"x-text\" style=\"\" ><h4 style=\"text-align: center;\"><span style=\"color: #000000;\">Questions?<\/span><\/h4>\n<div style=\"text-align: center;\">\n<div><span style=\"color: #000000;\">Please contact<\/span><\/div>\n<div><strong><span style=\"color: #000000;\">Doreen Lucadamo, CMP, DES, HMCC<\/span><\/strong><\/div>\n<div><i>Sr. Program Coordinator, Courses\/Conferences<\/i><\/div>\n<\/div>\n<div style=\"text-align: center;\"><a data-cke-saved-href=\"mailto:dlucadamo@som.umaryland.edu?subject=PUG%20Course%20Information%20-%20Website\" href=\"mailto:dlucadamo@som.umaryland.edu?subject=PUG%20Course%20Information%20-%20Website\"><span style=\"color: #0000ff;\"><strong>dlucadamo@som.umaryland.edu<\/strong><\/span><\/a><span style=\"color: #000000;\"> \u2666 Phone: 443-562-8630<\/span><\/div>\n<div style=\"text-align: center;\"><span style=\"color: #000000;\">University of Maryland School of Medicine \u2666 Department of Emergency Medicine<\/span><\/div>\n<div style=\"text-align: center;\"><span style=\"color: #000000;\"> <\/span><span style=\"color: #000000;\">110 S. Paca Street,\u00a0<\/span><span style=\"color: #000000;\">Sixth Floor, Suite 200,\u00a0<\/span><span style=\"color: #000000;\">Baltimore, MD 21201<\/span><\/div>\n<\/div><\/div><\/div><\/div><\/div>\n","protected":false},"excerpt":{"rendered":"<p>REGISTRATION FORMIf you have attended a previous UMEM Conference, you will need to make sure you are logged in with your website account before registering for this course. If you &#8230; <\/p>\n<div><a href=\"https:\/\/cms.umem.org\/index.php\/tcp25-main\/registration-tcp-2025-form\/\" class=\"more-link\">Read More<\/a><\/div>\n","protected":false},"author":4903,"featured_media":0,"parent":12429,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"template-blank-4.php","meta":{"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"footnotes":""},"class_list":["post-12546","page","type-page","status-publish","hentry","no-post-thumbnail"],"_links":{"self":[{"href":"https:\/\/cms.umem.org\/index.php\/wp-json\/wp\/v2\/pages\/12546","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/cms.umem.org\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/cms.umem.org\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/cms.umem.org\/index.php\/wp-json\/wp\/v2\/users\/4903"}],"replies":[{"embeddable":true,"href":"https:\/\/cms.umem.org\/index.php\/wp-json\/wp\/v2\/comments?post=12546"}],"version-history":[{"count":7,"href":"https:\/\/cms.umem.org\/index.php\/wp-json\/wp\/v2\/pages\/12546\/revisions"}],"predecessor-version":[{"id":12598,"href":"https:\/\/cms.umem.org\/index.php\/wp-json\/wp\/v2\/pages\/12546\/revisions\/12598"}],"up":[{"embeddable":true,"href":"https:\/\/cms.umem.org\/index.php\/wp-json\/wp\/v2\/pages\/12429"}],"wp:attachment":[{"href":"https:\/\/cms.umem.org\/index.php\/wp-json\/wp\/v2\/media?parent=12546"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}