ATTENDEE REGISTRATION FORM 2012 by 23K0Jb

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									                                         ---ATTENDEE REGISTRATION FORM---
                                                 Florida Biomedical Society
                                                 Symposium & Trade Show
                                                   October 26th-28th, 2012
                                                        Personal Information:
   Name: _______________________________                        Position: ______________________________

   Facility/Company: ____________________________________________
   Address: ___________________________________________________
   City, State and Zip: ___________________________________________

   Work Phone: (    ) __________________                        Fax: (    ) _________________________

   Email—required for confirmation: ___________________________________________________
   Attending Awards Luncheon? How many in your party? _________ (Limited Seating RSVP Required)


   Select   Location                                    Program Choices                                         Date\Time
     □         Salon I     Biomedical Finance                                                          Oct 27: 8:00 AM - 9:15 AM
     □        Salon II     Breakdown and Maintenance of Linet Hospital beds                            Oct 27: 8:00 AM - 9:15 AM
     □       Salon III     Healthcare Technology Management Update                                     Oct 27: 8:00 AM - 9:15 AM
     □      St. James A    Introduction to Servicing R/F Systems ( Part 1 )                            Oct 27: 8:00 AM - 9:15 AM
     □      St. James B    CE Evolving Role and Impact on Medical Device Security & Compliance         Oct 27: 8:00 AM - 9:15 AM
     □         Salon I     Centrifuge Repair ( part 1 )                                                Oct 27: 9:30 AM - 10:45 AM
     □        Salon II     The Impact of the Internet on Medical Equipment Maintenance                 Oct 27: 9:30 AM - 10:45 AM
     □       Salon III     Power Quality for the Biomed and X-Ray Technician ( Part 1 )                Oct 27: 9:30 AM - 10:45 AM
     □      St. James A    Introduction to Servicing R/F Systems ( Part 2 )                            Oct 27: 9:30 AM - 10:45 AM
     □      St. James B    Quality Assurance Phantoms for Ultrasound                                   Oct 27: 9:30 AM - 10:45 AM
     □         Salon I     Centrifuge Repair ( part 2 )                                                Oct 27: 10:45 AM - Noon
     □        Salon II     Hazard and Recall processing                                                Oct 27: 10:45 AM - Noon
     □       Salon III     Power Quality for the Biomed and X-Ray Technician ( Part 2 )                Oct 27: 10:45 AM - Noon
     □      St. James A    Contrast Injector First Response Training ( Part 1 )                        Oct 27: 10:45 AM - Noon
     □      St. James B    Performing Diagnostic Ultrasound PM that really Matters                     Oct 27: 10:45 AM - Noon
     □         Salon I     Healthcare IT Training from the Federal Government                          Oct 27: 1:45 PM - 3:00 PM
     □        Salon II     Benchmarking: How and Why                                                   Oct 27: 1:45 PM - 3:00 PM
     □       Salon III     Anesthesia Machine Fundamentals                                             Oct 27: 1:45 PM - 3:00 PM
     □      St. James A    Contrast Injector First Response Training ( Part 2 )                        Oct 27: 1:45 PM - 3:00 PM
     □      St. James B    Philips MRX defibrillator Maintenance                                       Oct 27: 1:45 PM - 3:00 PM


2012 FBS Golf Tournament Registration
                                                                         □ Member _ FREE - Fee Waived (A $35.00 Benefit for Members)
Osprey Ridge Golf Course
October 26th @ 8:00 A.M.                                                 □ Non-Member _ $15 (Includes FBS Membership @ Large)
• Transportation Provided
• Boxed Lunch
                                                                         □ Student _ FREE- (Must have Valid Student ID @ time of
• Awards                                                                 Registration)
Include $125 tournament fee to secure your slot
                                                                         Registration Fees Due    $_________________
Indicate additional names of players in your foursome
                                                                         Golf Fees: $125.00       $_________________
Player 2: ______________________________
                                                                         TOTAL:                   $_________________
Player 3: ______________________________
Player 4: ______________________________                                 Please, return form with payment to FBS:
—OR—                                                                                                         PO Box 43-0838
Individuals will be placed in foursome by tournament                                                         S Miami, FL 33243-0838
organizers.                                                                       OR Email to Bill.Hascup@trimedx.com
Each player must register separately for the symposium

         Hotel accommodations must be arranged directly @ www.FBSOnline.net or with Disney’s Boardwalk Resort
         (407)939-4686

								
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