311777 5/30/2017 CITY OF CARMEL, INDIANA VENDOR: 00352485
JOHN P REDMOND FOUNDATION CHECK AMOUNT: $ ...1,000.00`
ONE CIVIC SQUARE DOMINICK R BARBARA CONFERENCE-IAFC CHECK NUMBER: 311777
° CARMEL, INDIANA 46032 1750 NEW YORK AVE,NM CHECK DATE: 05/30/17
'M oN WASHINGTON DC 20006
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT EXTERNAL DESCRIPTION
INSTRUCT FEE
1120 4357004 1,000.00
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GISTRATION FORM
TWO WAYS TO REGISTER
• Register online at www.iaff.org/redmondems
• Download and complete the registration form. Send with payment to:
John P. Redmond Symposium/Dominick F. Barbera Conference
International Association of Fire Fighters
Attention: Karen Pressley, Health and Safety
1750 New York Avenue, NW
Washington, DC 20006-5395
Registration includes welcome reception, all plenary sessions, workshops, handouts, events
and breaks. Hotel room and meals are at the cost of the individual registrant.
ONLY ONE REGISTRANT PER FORM. Registration fees are payable by check,Visa or MasterCard.
.......................................................................................................................................................................................................................................................
Monday, August 7
Pre-Conference Events (Select one if you plan to attend a pre-conference event)
❑ Burn Prevention, Education and Treatment
❑ Fire Ground Survival (FGS) Practical Workshop
❑ Peer Support Continuing Education
❑ Performance Redefined: Assessment and Program Design (PFT Workshop)
❑Tactical Emergency Casualty Care (TECC)
Tuesday, August 8
Information Sessions 7 A (Select one)
❑Ask the Doc*
❑Ask the Keynote
HAsk the Trainer (FGS and PFT)
❑ Behavioral Health and Peer Support
❑ Big Data Analytics for the Fire Service: FireCARES and NFORS Exposure App*
❑ Drones (UAVs) and Firefighting
❑ FBI and Homegrown Violent Extremist (HVE)Threat Brief*
❑GPS Cancer
❑ NFPA EMS Standards and Regulations
Information Sessions 1 B (Select one)
❑Ask the Doc*
❑ Big Data Analytics for the Fire Service: FireCARES and NFORS Exposure App*
❑ Emergency Medical Dispatch (EMD) Communications
❑ EMS Community Engagement & Social Interaction
CEJ FBI Homegrown Violent Extremist (HVE) Brief*
❑ Flame Retardants and TSCA
❑ IAFF Center of Excellence for Behavioral Health Treatment and Recovery
❑Wildland Fire Fighter Exposure Study
[]World Trade Center (WTC) Health
❑Writing Winning Grants
*Offered more than once
2
Wednesday, August 9
Workshops 1 A (Select one)
❑ Building Resilience in the Fire Service*
❑Carbon Monoxide and Cyanide Poisoning
❑/Fire-Based EMS in Canada: A Cross-Country Checkup
Ca3Fit for Duty
❑ MAYDAY: A Realistic View of the Fireground and the Challenges We Face
❑ Multi-Threat Response: Active Shooter/Fire as a Weapon
❑Occupational Cancer and the Use of Screening Procedures*
❑ Personal Protective Equipment (PPE)
❑ Rescue Task Force: Understanding the Concept and Deployment
❑ Responding to the Interface: Urban Interface Fire Operations
Workshops 1 B (Select one)
❑ Building Resilience in the Fire Service*
❑Community Paramedic: Successes and Lessons Learned
❑ Drug Lab Hazards and the FDNY LODD Case Study
❑ Fire and EMS Response During Civil Unrest
❑ Fire-Based EMS: ATale of Two Provinces
❑ Fire-Based EMS: Responding to the Opioid Crisis*
❑ Fire Dynamics and Tactical Considerations*
❑Occupational Cancer and the Use of Screening Procedures*
❑Stamp Out Stigma*
li1WFI 4th Edition
*Offered more than once
3
Thursday, August 10
Workshops 2A (Select one)
❑Cardiovascular Disease: Beyond the Numbers*
❑Communications: Can Anyone HearYou?
❑ Fire-Based EMS: Responding to the Opioid Crisis*
/Fire Dynamics and Tactical Considerations*
❑ EMS Response to Sex Trafficking*
❑ Minimize Injuries...MAXIMIZE LIFE!*
❑ Paramedic Assault
❑ Preparedness, Response, Resilience, and Your Workload: Assessing Response
Resource Capacity and Capability*
❑ Responding to IEDs:Threats and Preparedness*
❑Stamp Out Stigma*
❑Teaching Our Own: Building a Fire Department-Based Paramedic Training Program
Workshops 2B (Select one)
❑Capturing Revenue
❑Cardiovascular Disease: Beyond the Numbers*
❑Changing of the Fire Service:The Evolution of Decontamination and Cancer Prevention
❑ Emergency Vehicle Safety: Surviving the Response
❑ EMS Response to Sex Trafficking*
I /Minimize Injuries...MAXIMIZE LIFE!*
❑ Nutrition:The Fuel to Fight
❑ Preparedness, Response, Resilience, and Your Workload: Assessing Response Resource Capacity
and Capability*
❑ Responding to IEDs:Threats and Preparedness*
❑Stored Energy and the Hidden Dangers (Solar Power & Lithium Batteries)
❑Suicide in the Fire Service
*Offered more than once
4
Name
IAFF Local Name and Number 10 S `6S- D Z
Address a 2643 &1,,64 &A
City t V State — Province Zip Code
Phone Number 11' " 15q 5 Z
Email '�i�E�''r9 Lit flu L,t Cz>
Register
w/U.S. Members: $500 (USD) ❑Canadian Members: $400 (USD)
Check— U.S./Canadian members please make check payable to the John P. Redmond
Symposium/EMS Conference.
o Visa/MasterCard (complete credit card information below)
o I want to make a separate voluntary contribution to FIREPAC in the amount of $
but not have it credited toward my conference registration.
Register With FIREPAC
IAFF members can make a FIREPAC contribution and register in one step.The FIREPAC
option is available only to IAFF members as U.S. federal election law prohibits the solicitation
of non-IAFF members.
U.S. Members:Your personal, voluntary FIREPAC contribution by personal check or credit card
of $500 or more provides you membership in the FIREPAC Leadership Trust ($500) or Chairman's
Council ($750) and automatically registers you for the Symposium/Conference. U.S. members who
select one of the FIREPAC options to register must submit a personal check payable to IAFF
FIREPAC or use a personal credit card. U.S. members cannot use a union or corporate check/
credit card or seek reimbursement for their contribution to FIREPAC.Additionally, one person
cannot write a personal check, purchase a money order or use a personal credit card to cover
multiple registrants when contributing to FIREPAC. Please note that contributions to FIREPAC
are not tax deductible for federal income tax purposes. Previous FIREPAC contributions and monthly
deductions via FIREPAC Check-Off cannot be applied toward this FIREPAC registration option.
Your decision to contribute via this FIREPAC option is purely voluntary and the amounts suggested to contribute
to FIREPAC are merely guidelines.You are free to contribute more or less than the guidelines and you will not be
favored or disadvantaged by reason of the amount of your contribution or decision not to contribute to FIREPAC.
5
FIREPAC LeadershipTrust
❑$500 (USD/CAD) — I would like to join the FIREPAC Leadership Trust and register for the
Symposium/Conference at the same time.
o Check— U.S. members please make personal check payable to IAFF FIREPAC.
Canadian members: Please make check payable to IAFF FIREPAC Canada.
o Visa/MasterCard (complete credit card information on next page)
Leadership Trust members will receive a Leadership Trust pin and recognition on the IAFF website.
FIREPAC Chairman's Council
❑$750 (USD/CAD) — I would like to join the FIREPAC Chairman's Council and register for the
Symposium/Conference at the same time.
o Check— U.S. members please make personal check payable to IAFF FIREPAC.
Canadian members: Please make check payable to IAFF FIREPAC Canada.
o Visa/MasterCard (complete credit card information on next page)
Chairman's Council members will receive a Chairman's Council pin,a custom IAFF garment bag and luggage tag
and recognition on the IAFF website.
Credit Card Payment
❑Visa ❑MasterCard
Name
Card Number Expiration date
Signature
NOTE to U.S. members only.If contributing to either the FIREPAC Chairman's Council or Leadership Trust,
members must use a personal credit card.
6
� - 11, 'RE GISTRATION FORM
TWO WAYSTO REGISTER
• Register online at www.iaff.org/redmondems
• Download and complete the registration form. Send with payment to:
John P. Redmond Symposium/Dominick F. Barbera Conference
International Association of Fire Fighters
Attention: Karen Pressley, Health and Safety
1750 New York Avenue, NW
Washington, DC 20006-5395
Registration includes welcome reception, all plenary sessions, workshops, handouts, events
and breaks. Hotel room and meals are at the cost of the individual registrant.
ONLY ONE REGISTRANT PER FORM. Registration fees are payable by check,Visa or MasterCard.
.......................................................................................................................................................................................................................................................
Monday, August 7
Pre-Conference Events (Select one if you plan to attend a pre-conference event)
❑ Burn Prevention, Education and Treatment
❑ Fire Ground Survival (FGS) Practical Workshop
❑ Peer Support Continuing Education
❑ Performance Redefined: Assessment and Program Design (PFT Workshop)
❑Tactical Emergency Casualty Care (TECC)
Tuesday, August 8
Information Sessions 1A (Select one)
❑Ask the Doc*
❑/Ask the Keynote
2Ask the Trainer (FGS and PFT)
❑ Behavioral Health and Peer Support
❑ Big Data Analytics for the Fire Service: FireCARES and NFORS Exposure App*
❑ Drones (UAVs) and Firefighting
❑ FBI and Homegrown Violent Extremist (HVE)Threat Brief*
❑GPS Cancer
❑ NFPA EMS Standards and Regulations
Information Sessions 1 B (Select one)
❑Ask the Doc*
❑ Big Data Analytics for the Fire Service: FireCARES and NFORS Exposure App*
❑ Emergency Medical Dispatch (EMD) Communications
❑ EMS Community Engagement & Social Interaction
❑ FBI Homegrown Violent Extremist (HVE) Brief*
❑ Flame Retardants and TSCA
❑ IAFF Center of Excellence for Behavioral Health Treatment and Recovery
❑Wildland Fire Fighter Exposure Study
orldTrade Center (WTC) Health
writing Winning Grants
*Offered more than once
2
Wednesday, August 9
Workshops 1 A (Select one)
❑ Building Resilience in the Fire Service*
❑Carbon Monoxide and Cyanide Poisoning
❑ Fire-Based EMS in Canada: A Cross-Country Checkup
/Fit for Duty
❑ MAYDAY: A Realistic View of the Fireground and the Challenges We Face
❑ Multi-Threat Response: Active Shooter/Fire as a Weapon
❑Occupational Cancer and the Use of Screening Procedures*
❑ Personal Protective Equipment (PPE)
❑ Rescue Task Force: Understanding the Concept and Deployment
❑ Responding to the Interface: Urban Interface Fire Operations
Workshops 11113 (Select one)
❑ Building Resilience in the Fire Service*
❑Community Paramedic: Successes and Lessons Learned
❑ Drug Lab Hazards and the FDNY LODD Case Study
❑ Fire and EMS Response During Civil Unrest
❑ Fire-Based EMS: ATale of Two Provinces
l❑ ire-Based EMS: Responding to the Opioid Crisis*
Fire Dynamics and Tactical Considerations*
❑Occupational Cancer and the Use of Screening Procedures*
❑Stamp Out Stigma*
❑WFI 4th Edition
*Offered more than once
3
Thursday, August 10
Workshops 2A (Select one)
❑Cardiovascular Disease: Beyond the Numbers*
❑Communications: Can Anyone Hear You?
❑ Fire-Based EMS: Responding to the Opioid Crisis*
❑ Fire Dynamics and Tactical Considerations*
S Response to Sex Trafficking*
minimize Injuries...MAXIMIZE LIFE!*
❑ Paramedic Assault
❑ Preparedness, Response, Resilience, and Your Workload: Assessing Response
Resource Capacity and Capability*
❑ Responding to IEDs:Threats and Preparedness*
❑Stamp Out Stigma*
❑Teaching Our Own: Building a Fire Department-Based Paramedic Training Program
Workshops 2113 (Select one)
❑Capturing Revenue
❑Cardiovascular Disease: Beyond the Numbers*
❑Changing of the Fire Service:The Evolution of Decontamination and Cancer Prevention
❑ Emergency Vehicle Safety: Surviving the Response
❑ EMS Response to SexTrafficking*
❑Minimize Injuries...MAXIMIZE LIFE!*
/Nutrition:The Fuel to Fight
❑ Preparedness, Response, Resilience, and Your Workload: Assessing Response Resource Capacity
and Capability*
❑ Responding to IEDs:Threats and Preparedness*
❑Stored Energy and the Hidden Dangers (Solar Power & Lithium Batteries)
❑Suicide in the Fire Service
*Offered more than once
4
Name j"t I r j 1J
IAFF Local Name and Number �"l 7 W
Address 1>q Z'$ Cr*.1J k.^J R� PLA
City C Nd-y" Er L State— Province Zip Code C/U 3
Phone Number S I 1 50 Z " ch E I
Email Tf.0(LI (Fl rl Co LgL4q� • GV k"
Register
2 U.S. Members: $500 (USD) ❑Canadian Members: $400 (USD)
/Check— U.S./Canadian members please make check payable to the John P. Redmond
Symposium/EMS Conference.
o Visa/MasterCard (complete credit card information below)
o I want to make a separate voluntary contribution to FIREPAC in the amount of $
but not have it credited toward my conference registration.
Register With FIREPAC
IAFF members can make a FIREPAC contribution and register in one step.The FIREPAC
option is available only to IAFF members as U.S. federal election law prohibits the solicitation
of non-IAFF members.
U.S. Members:Your personal, voluntary FIREPAC contribution by personal check or credit card
of $500 or more provides you membership in the FIREPAC Leadership Trust ($500) or Chairman's
Council ($750) and automatically registers you for the Symposium/Conference. U.S. members who
select one of the FIREPAC options to register must submit a personal check payable to IAFF
FIREPAC or use a personal credit card. U.S. members cannot use a union or corporate check/
credit card or seek reimbursement for their contribution to FIREPAC.Additionally, one person
cannot write a personal check, purchase a money order or use a personal credit card to cover
multiple registrants when contributing to FIREPAC. Please note that contributions to FIREPAC
are not tax deductible for federal income tax purposes. Previous FIREPAC contributions and monthly
deductions via FIREPAC Check-Off cannot be applied toward this FIREPAC registration option.
Your decision to contribute via this FIREPAC option is purely voluntary and the amounts suggested to contribute
to FIREPAC are merely guidelines.You are free to contribute more or less than the guidelines and you will not be
favored or disadvantaged by reason of the amount of your contribution or decision not to contribute to FIREPAC.
5
FIREPAC LeadershipTrust
❑$500 (USD/CAD) — I would like to join the FIREPAC Leadership Trust and register for the
Symposium/Conference at the same time.
o Check— U.S. members please make personal check payable to IAFF FIREPAC.
Canadian members: Please make check payable to IAFF FIREPAC Canada.
o Visa/MasterCard (complete credit card information on next page)
Leadership Trust members will receive a Leadership Trust pin and recognition on the IAFF website.
FIREPAC Chairman's Council
❑$750 (USD/CAD) — I would like to join the FIREPAC Chairman's Council and register for the
Symposium/Conference at the same time.
o Check— U.S. members please make personal check payable to IAFF FIREPAC.
Canadian members: Please make check payable to IAFF FIREPAC Canada.
o Visa/MasterCard (complete credit card information on next page)
Chairman's Council members will receive a Chairman's Council pin,a custom IAFF garment bag and luggage tag
and recognition on the IAFF website.
Credit Card Payment
❑Visa ❑ MasterCard
Name
Card Number Expiration date
Signature
NOTE to U.S. members only. If contributing to either the FIREPAC Chairman's Council or Leadership Trust,
members must use a personal credit card.
6