{"id":16213,"date":"2026-05-22T11:03:45","date_gmt":"2026-05-22T15:03:45","guid":{"rendered":"https:\/\/cms.umem.org\/?page_id=16213"},"modified":"2026-05-22T12:06:21","modified_gmt":"2026-05-22T16:06:21","slug":"ccs26-registration","status":"publish","type":"page","link":"https:\/\/cms.umem.org\/index.php\/critical-care-symposium-2026\/ccs26-registration\/","title":{"rendered":"CCS26-REGISTRATION"},"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: #ffffff;\" ><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: #ffffff;\"><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 e16213-e4 mcid-0 mcid-1 mcid-2 mcid-5 mcid-6\"><div class=\"x-row-inner\"><div class=\"x-col e16213-e5 mcid-9\"><img decoding=\"async\"  class=\"x-img x-img-none\"  src=\"https:\/\/cms.umem.org\/wp-content\/uploads\/2026\/05\/ccs-logo-2-e1778676229673.png\" ><h2  class=\"h-custom-headline h3\" ><span>Lectures go live Wednesday, July 15, 2026<\/span><\/h2><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 e16213-e9 mcid-0 mcid-1 mcid-3 mcid-5 mcid-7\"><div class=\"x-row-inner\"><div class=\"x-col e16213-e10 mcid-9\"><div class=\"x-text x-content e16213-e11 mcid-b\"><p><span style=\"color: #ff0000;\"><strong>If you attended any of our education events since 2020,<\/strong><\/span>\u00a0you 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 INFORMATION:<br \/>\n<\/strong>This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education through the joint providership of the Center for Emergency Medical Education and the University of Maryland Department of Emergency Medicine.<\/p>\n<p>\u201cThe Center for Emergency Medical Education is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.\u201d The Center for Emergency Medical Education designates this live activity for a maximum of <em><strong>3.00 AMA PRA Category 1 Credits<\/strong><\/em>\u2122.<\/p>\n<p>Physicians should claim only the credit commensurate with the extent of their participation in the activity.<\/p><\/div><hr  class=\"x-gap\" style=\"margin: 25px 0 0 0;\"><\/div><div class=\"x-col e16213-e13 mcid-9\"><div class=\"x-content-area e16213-e14 mcid-c\"><p style=\"text-align: left;\"><strong>REGISTRATION INFO:<\/strong><br \/><strong>Registration is FREE.<\/strong> CME is available for $150 and a Certificate of Participation for $15.<\/p>\n<p style=\"text-align: left;\">If you have any challenges or questions, email <a href=\"mailto:dlucadamo@som.umaryland.edu\">dlucadamo@som.umaryland.edu<\/a><\/p>\n<p style=\"text-align: left;\"><span style=\"color: #000000;\"><strong><em>If you have never registered for one of our courses since 2020, 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>\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\" data-toggle=\"0\" aria-label=\"Show 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no_prefix has_first_name no_middle_name has_last_name has_suffix gf_name_has_3 ginput_container_name gform-grid-row' id='input_108_1'>\n                            \n                            <span id='input_108_1_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_1.3' id='input_108_1_3' value='' tabindex='2'  aria-required='true'     \/>\n                                                    <label for='input_108_1_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_108_1_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_1.6' id='input_108_1_6' value='' tabindex='4'  aria-required='true'     \/>\n                          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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_108_2_container'>\n                                <span id='input_108_2_1_container' class='ginput_left gform-grid-col gform-grid-col--size-auto'>\n                                    <input class='' type='email' name='input_2' id='input_108_2' value='' tabindex='6'   aria-required=\"true\" aria-invalid=\"false\"  \/>\n                                    <label for='input_108_2' class='gform-field-label gform-field-label--type-sub '>Enter Email<\/label>\n                                <\/span>\n                                <span id='input_108_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_108_2_2' 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          <label for='input_108_12_2' id='input_108_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_108_12_3_container' >\n                                    <input type='text' name='input_12.3' id='input_108_12_3' value='' tabindex='10'   aria-required='true'    \/>\n                                    <label for='input_108_12_3' id='input_108_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_108_12_4_container' >\n                                        <input type='text' name='input_12.4' id='input_108_12_4' value='' tabindex='12'     aria-required='true'    \/>\n                                        <label for='input_108_12_4' id='input_108_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_108_12_5_container' >\n                                    <input type='text' name='input_12.5' id='input_108_12_5' value='' tabindex='13'   aria-required='true'    \/>\n                                    <label for='input_108_12_5' id='input_108_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_108_12_6_container' >\n                                        <select name='input_12.6' id='input_108_12_6' tabindex='14'  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_108_12_6' id='input_108_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_108_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_108_31'>Please check all that apply.<\/div><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_108_31'><div class='gchoice gchoice_108_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_108_31_1' tabindex='15'  aria-describedby=\"gfield_description_108_31\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_108_31_1' id='label_108_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_108_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_108_31_2' tabindex='16'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_108_31_2' id='label_108_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_108_31_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_31.3' type='checkbox'  value='NP'  id='choice_108_31_3' tabindex='17'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_108_31_3' id='label_108_31_3' class='gform-field-label gform-field-label--type-inline'>NP<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_108_31_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_31.4' type='checkbox'  value='PA'  id='choice_108_31_4' tabindex='18'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_108_31_4' id='label_108_31_4' class='gform-field-label gform-field-label--type-inline'>PA<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_108_31_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_31.5' type='checkbox'  value='RN'  id='choice_108_31_5' tabindex='19'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_108_31_5' id='label_108_31_5' class='gform-field-label gform-field-label--type-inline'>RN<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_108_31_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_31.6' type='checkbox'  value='LPN'  id='choice_108_31_6' tabindex='20'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_108_31_6' id='label_108_31_6' class='gform-field-label gform-field-label--type-inline'>LPN<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_108_31_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_31.7' type='checkbox'  value='EMT'  id='choice_108_31_7' tabindex='21'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_108_31_7' id='label_108_31_7' class='gform-field-label gform-field-label--type-inline'>EMT<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_108_31_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_31.8' type='checkbox'  value='Medical Student'  id='choice_108_31_8' tabindex='22'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_108_31_8' id='label_108_31_8' 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_108_31_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_31.9' type='checkbox'  value='Resident'  id='choice_108_31_9' tabindex='23'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_108_31_9' id='label_108_31_9' class='gform-field-label gform-field-label--type-inline'>Resident<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_108_31_11'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_31.11' type='checkbox'  value='Fellow'  id='choice_108_31_11' tabindex='24'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_108_31_11' id='label_108_31_11' class='gform-field-label gform-field-label--type-inline'>Fellow<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_108_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_108_31_12' tabindex='25'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_108_31_12' id='label_108_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_108_39\" 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\">Hospital Information<\/h3><\/div><div id=\"field_108_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_108_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_108_13' type='text' value='' class='medium'   tabindex='26'  aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_108_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_108_14' >\n                        <span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_108_14_3_container' >\n                                    <input type='text' name='input_14.3' id='input_108_14_3' value='' tabindex='28'   aria-required='true'    \/>\n                                    <label for='input_108_14_3' id='input_108_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_108_14_4_container' >\n                                        <input type='text' name='input_14.4' id='input_108_14_4' value='' tabindex='30'     aria-required='true'    \/>\n                                        <label for='input_108_14_4' id='input_108_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_108_14_6_container' >\n                                        <select name='input_14.6' id='input_108_14_6' tabindex='32'  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_108_14_6' id='input_108_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_108_38\" 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<\/h3><\/div><div id=\"field_108_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_108_4'>Registration Category<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_108_4'>The Emergency Cardiology Symposium 2026 is FREE to everyone who wishes to participate.\nPHYSICIANS: looking to earn CME for your participation, there is a $150 registration fee. CME information coming soon. Please see website for more details about the CME provided.\n\nFor those that do not need CME but would like a Certificate of Participation sent to them after the event we have added this option for $15.<\/div><div class='ginput_container ginput_container_select'><select name='input_4' id='input_108_4' class='medium gfield_select' tabindex='33' aria-describedby=\"gfield_description_108_4\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='0' selected='selected'>FREE Registration (No CME)<\/option><option value='15' >Certificate of Participation $15<\/option><option value='150' >Physician Registration (CME Available $150)<\/option><\/select><\/div><\/div><div id=\"field_108_8\" 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_108_8'>Registration FREE Backend<\/label><div class='ginput_container ginput_container_select'><select name='input_8' id='input_108_8' class='medium gfield_select' tabindex='34'    aria-invalid=\"false\" ><option value='15021' selected='selected'>FREE Registration<\/option><\/select><\/div><\/div><div id=\"field_108_41\" 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_108_41'>Registration COP Backend<\/label><div class='ginput_container ginput_container_select'><select name='input_41' id='input_108_41' class='large gfield_select' tabindex='35'    aria-invalid=\"false\" ><option value='16125' selected='selected'>COP Registration<\/option><\/select><\/div><\/div><div id=\"field_108_33\" 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_108_33'>Registration CME Backend<\/label><div class='ginput_container ginput_container_select'><select name='input_33' id='input_108_33' class='medium gfield_select' tabindex='36'    aria-invalid=\"false\" ><option value='16126' selected='selected'>CME Registration<\/option><\/select><\/div><\/div><div id=\"field_108_43\" 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\">Communication<\/h3><\/div><fieldset id=\"field_108_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_108_32'>Please check all that apply.<\/div><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_108_32'><div class='gchoice gchoice_108_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_108_32_1' tabindex='37'  aria-describedby=\"gfield_description_108_32\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_108_32_1' id='label_108_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_108_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_108_32_2' tabindex='38'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_108_32_2' id='label_108_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_108_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_108_32_3' tabindex='39'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_108_32_3' id='label_108_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_108_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_108_32_4' tabindex='40'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_108_32_4' id='label_108_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_108_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_108_32_5' tabindex='41'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_108_32_5' id='label_108_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_108_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_108_32_6' tabindex='42'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_108_32_6' id='label_108_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_108_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_108_32_7' tabindex='43'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_108_32_7' id='label_108_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_108_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_108_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_108_30' class='medium gfield_select' tabindex='44'   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 the Emergency Cardiology Symposium' >No, I would only like to receive emails pertaining the Emergency Cardiology Symposium<\/option><\/select><\/div><\/div><div id=\"field_108_44\" 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\">Payment Information<\/h3><\/div><div id=\"field_108_22\" class=\"gfield gfield--type-coupon gfield--input-type-coupon field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='gf_coupon_code_108'>Coupon<\/label><div class='ginput_container' id='gf_coupons_container_108'><div class='ginput_container_coupon'><input id='gf_coupon_code_108' class='gf_coupon_code' onkeyup='DisableApplyButton(108);' onchange='DisableApplyButton(108);' onpaste='setTimeout(function(){DisableApplyButton(108);}, 50);' type='text'    tabindex='45'\/><input type='button' disabled='disabled' onclick='ApplyCouponCode(108);' value='Apply' id='gf_coupon_button' class='button'  tabindex='46'\/> <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_108' name='input_22' value=''  \/><input type='hidden' id='gf_total_no_discount_108'\/><input type='hidden' id='gf_coupons_108' name='gf_coupons_108' value='' \/><\/div><\/div><div id=\"field_108_11\" class=\"gfield gfield--type-product gfield--input-type-calculation gfield_visibility_hidden gfield_price gfield_price_108_11 gfield_product_108_11 gfield_calculation 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_108_11_1'>Total<\/label><div class='ginput_container ginput_container_product_calculation'>\n\t\t\t\t\t<input type='hidden' name='input_11.1' value='Total' class='gform_hidden' \/>\n\t\t\t\t\t<div id='ginput_product_price_108_11' class='ginput_product_price_wrapper'>\n\t\t\t\t\t\t<span class='gform-field-label gform-field-label--type-sub-large ginput_product_price_label'>Price:<\/span>\n\t\t\t\t\t\t<span class='gform-field-label gform-field-label--type-sub-large ginput_product_price' id='input_108_11'>$0.00<\/span>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<input type='hidden' name='input_11.2' id='ginput_base_price_108_11' class='gform_hidden ginput_calculated_price' value='$0.00'\/>\n\t\t\t\t\t<input type='hidden' name='input_11.3' value='1' class='ginput_quantity_108_11 gform_hidden' \/>\n\t\t\t\t<\/div><\/div><div id=\"field_108_35\" class=\"gfield gfield--type-text gfield--input-type-text 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_108_35'>User Logged In? 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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;\">Program &amp; Events Team<\/span><\/strong><\/div>\n<div><a href=\"mailto:umem.conferences@som.umaryland.edu\">umem.conferences@som.umaryland.edu<\/a><\/div>\n<\/div>\n<\/div><div id=\"\" class=\"x-text\" style=\"\" ><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>Lectures go live Wednesday, July 15, 2026REGISTRATION FORMIf you attended any of our education events since 2020,\u00a0you will need to make sure you are logged in with your website account &#8230; <\/p>\n<div><a href=\"https:\/\/cms.umem.org\/index.php\/critical-care-symposium-2026\/ccs26-registration\/\" class=\"more-link\">Read More<\/a><\/div>\n","protected":false},"author":3,"featured_media":0,"parent":15784,"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-16213","page","type-page","status-publish","hentry","no-post-thumbnail"],"_links":{"self":[{"href":"https:\/\/cms.umem.org\/index.php\/wp-json\/wp\/v2\/pages\/16213","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\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/cms.umem.org\/index.php\/wp-json\/wp\/v2\/comments?post=16213"}],"version-history":[{"count":7,"href":"https:\/\/cms.umem.org\/index.php\/wp-json\/wp\/v2\/pages\/16213\/revisions"}],"predecessor-version":[{"id":16220,"href":"https:\/\/cms.umem.org\/index.php\/wp-json\/wp\/v2\/pages\/16213\/revisions\/16220"}],"up":[{"embeddable":true,"href":"https:\/\/cms.umem.org\/index.php\/wp-json\/wp\/v2\/pages\/15784"}],"wp:attachment":[{"href":"https:\/\/cms.umem.org\/index.php\/wp-json\/wp\/v2\/media?parent=16213"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}