KMESA
KEMSA
KMESA
KEMSA
KEMSA
KMESAKEMSAKMESAKEMSAKEMSA

The 2014 KMESA Conference will be August 26-28th at the Griffin Gate Marriott in Lexington, KY

Attendee Registration Form

KMESA Fall Conference August 26-28, 2014 Attendee Registration Form

Company: ­­­­­­­­­­­­­­­­­__________________________________________________________________________________________________________

Contact Person: ­­­­­­___________________________________________________________________________________________________

Address: ___________________________________________________________________________________________________________

City: ___________________________________________State: _____ Zip: _______________

Phone: ________________________________________ Email: ___________________________________

Website: _____________________________________________________________

List Attendees (Names as they should appear on nametag)

  • 1.____________________________________________ Email: ______________________________ Education Course: _________________________
  • 2.____________________________________________ Email: ______________________________ Education Course: _________________________
  • 3.____________________________________________ Email: ______________________________ Education Course: _________________________

Tuesday, August 26, 2014 Educational Opportunities

  • 1.RenTrain Delivery Technician Certification Program Randy Schluter ($200 per student)

2.Shoe Fitting Class by Jason Laney of Hylan Shoes ($295 per student)

Certified Fitter of Therapeutic Shoes (CFts) Course.

Objective: This course will prepare student to take the exam and become Credentialed as a Certified Shoe Fitter. If you are ALREADY a CFts you can RETAKE this course and receive 12 Category 1 CEU's. You will have online coursework to complete to receive CEU's.

Wednesday, August 27, 2014 Educational Opportunity

Basic Foot Assessment Techniques 7.75 ($200 per student)

Category 2 CEU's

It's ok, if you have taken this CEU before., you can take it again for CEU's.

Thursday, August 28, 2014 Educational Opportunity

Advanced Gait Analysis 4.5 Category 1 CEU's($100 per student)

Objectives include: Exploring components of normal gait; Discuss muscle and joint activity during normal gait; Knowledge of commonly used terms; Use of basic observational components for gait analysis; Use of advanced observational components for gait analysis; Recognize pathological gait patterns.

Current KMESA Member: YESNO

Please indicate number of attendees for social of drinks & hors’ devours on Tuesday: ­­_____

Conference Attendee Cost for KMESA Members: $175 before August 15, 2014

After August 15, 2014: $225

Conference Attendee Cost for Non-KMESA Members: $275 before August 15, 2014

After August 15, 2014: $325

Education Course for KMESA Members: $200 per participant (unless otherwise specified)

Education Course for Non-KMESA Members: $300 per participant (unless otherwise specified)

Total Attendees_______

Total Amount Due $_______

Method of Payment:

Check Payable to KMESA (Mail to 1303 US 127 South Ste 402 #394 Frankfort, KY 40601)

Credit Care: VisaMastercard

Card #: __________________________Expiration Date: _____________________

Name on Card: ______________________________________________________

Card Billing Address: _______________________________________________

City: _________________________________ State: _____ Zip: _______________

Signature: __________________________________

Registration forms can be mailed (1303 US 127 South Ste 402 #394 Frankfort, KY 40601),

faxed (502.416.0328), or emailed (kymesa.org@gmail.com).

Exhibitor Registration Form

KMESA Fall Conference August 27, 2014 Lexington, KY

Company: __________________________________________________________

Contact Person: _____________________________________________________

Address: ___________________________________________________________

City: _________________________________ State: _____ Zip: _______________

Phone: ____________________ Email: ___________________________________

Website: ___________________________________________________________

Representatives Staffing Booth (Names as they should appear on nametag)

1. __________________________ Email: ______________________________

2. __________________________ Email: ______________________________

Evening with Exhibitors: Drinks & Hors’ devours. Please indicate number of attendees for social: ___

Current KMESA Member: YES NO or Joining or Renewing Membership YES NO

Gold Partner Membership $850.00 (Includes one free Conference booth)

Silver Partner Membership $650.00

Exhibit Booth Charges Cost

Non-Member Booth $600

Additional Table $100

Electricity at Booth (Bring extension cords) $50

Sponsorship Opportunities

Grand Sponsor $3000

Lunch Sponsor $1500

Keynote or Closing Speaker $1000

General Session Speaker $500

Refreshment Break $500

Evening with Exhibitors Food Sponsor $500

Break Out Speaker $250

Total Amount Due $_____

Method of Payment:

Check Payable to KMESA (Mail to 1303 US 127 South Ste 402 #394 Frankfort, KY 40601)

Credit Care: Visa Mastercard

Card #: __________________________Expiration Date: _____________________

Name on Card: ______________________________________________________

Card Billing Address: _________________________________________________

City: _________________________________ State: _____ Zip: _______________

Signature: __________________________________

Registration forms can be mailed (1303 US 127 South Ste 402 #394 Frankfort, KY 40601),

faxed (502.416.0328), or emailed (kymesa.org@gmail.com).

Call the Marriott Griffin Gate for a KMESA room rate, call 1.859.231.5100 for reservations.

Welcome to KMESA, the Kentucky Medical Equipment Suppliers Association. The purpose of KMESA is to function as a unified coalition of HME industry members with shared goals of:

  • Quality Patient Care
  • Industry Growth
  • 3rd Party Carrier Communications
  • Educational Opportunities
  • Strengthening policy that supports HME Providers
  • Networking with HME Providers and Manufacturers

  

Members Only
Facebook