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2021 SIM Team Registration

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1.
What is your Team Name
2.
Team Member 1 (Primary Contact person)
Please enter the first team member's information. They will also serve as the primary contact person.
3.
Level of Service
4.
Team Member 2
First Name
Last Name
Email
Phone
5.
Level of Service
6.
Photo Release:
All teams must be official registrants of the conference prior to competing in the competition Photo Release for Conference, SIM Competition, and/or Awards Program Pictures and Videos: I hereby authorize, by nature of registering for the 2021 National Conference on EMS, 2021 SIM Competition, and / or 2021 EMS Awards Program, the NJ Office of Emergency Medical Services the absolute right and unrestricted permission to copyright and/or use, and/or publish, photographic portraits or pictures of me, still single, multiple, or moving, or in which I may be included in whole or in part, or composite, or distorted in character or form, in conjunction with my own or another or fictitious name, or reproductions of these photographs, in color or otherwise, made through any media at studios or elsewhere for art, advertising, trade, or any other lawful purpose.