NASEMSO 2009 ANNUAL MEETING

Optional Outing Sign-up Form

Riverboat Dinner Cruise on the Arkansas River

Monday, September 21, 2009

REGISTRATION DEADLINE: TUESDAY, SEPTEMBER 15, 2009

Sit back and relax while the Arkansas Queen slowly takes you down the Arkansas River for a two-hour dinner cruise. The Arkansas Queen is an elegant three deck replicated steam wheeler. After dinner, snap your fingers, tap your feet or get up and dance – or enjoy this leisurely cruise by listening to music on the outside decks while watching the calming river waters, or gazing at the city lights, the moon and stars.

The $50.00 per person cost covers the riverboat cruise, two drink tickets, dinner buffet (includes coffee and tea), dinner gratuity and tax and post-dinner dance band. A cash bar will be available for purchase of additional cocktails, beer, wine and soft drinks.

We will depart the hotel at 6:15 p.m.and return at 9:15 p.m. The boat dock is a 10 minute walk from the hotel. If you require transportation to the dock, please check the appropriate space below.

PLEASE COMPLETE AND RETURN WITH PAYMENT TO:

NASEMSO • 201 PARK WASHINGTON COURT • FALLS CHURCH, VA22046 • FAX 703/241-5603

REGISTRATION DEADLINE: TUESDAY, SEPTEMBER 15, 2009

Via mail:201 Park Washington Court, Falls Church, VA22046

Via fax:703/241-5603

Via email:

The $50.00 per person cost includes the riverboat cruise, 2 drink tickets, dinner buffet (inclusive of tax and gratuity) and post-dinner dance band. A cash bar will be available for purchase of additional cocktails, beer, wine and soft drinks.

# of participants @ $50.00 per person Method of Payment: Check Credit Card

Charge to my credit card $ Card Type (check one): VISA MasterCard AmEx

Card # Expiration Date V-code #*

Billing Address for Credit Card:

Name on Card Signature and Date

*VISA and MasterCard – 3 digit number on back of card; AmEx – 4 digit number on front of card.

Check here if you require transportation to the boat dock (10 minute walk from the Peabody).

Your Name

State/Company/Organization

G/NASEMSO/meetings/2009 annual meeting/optional outing flyer