REGISTRATION FORM

                  Fourteenth ANNUAL PROVIDENCE FIREFIGHTER SAFETY &

                                            SURVIVAL CONFERENCE

Name:______________________________________________ Day Phone:_______________

Home Address:________________________________________________________________

City: ___________________________________ State :___________Zip:_________________

E-mail Address: ________________________________________________________

Fire Department: _______________________________________________________

NOTE: You may register for the conference only, the workshops only, or both.

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                                            CONFERENCE Wednesday, May 21, 2008

                                        (Please choose one morning and one afternoon session.)

            Morning Breakout Sessions 10:30 - Noon             Afternoon Breakout Sessions 3:30 - 5:00

____    Cocoanut Grove  - Grant                     ____    Engine Chauffeur - Lagrow/Healy

____    Air Management - Jutras                    ____     Firefighter Fatalities - Routley   

____    First line - Lagrow/Healy                     ____    Tower Ladder Operations - Crowley/Brown

                                Luncheon Selection----Wednesday, May 21, 2008

              _____Grilled Lemon Chicken       _____Baked Stuffed Scrod       _____Stuffed Shells (Vegetarian )

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             POST CONFERENCE WORKSHOPS - Thursday & Friday,  May 22nd & 23rd 2008                        

                   Workshops will be reserved when payment is received. Please indicate your 1^st and 2^nd choice.

                          All workshops will be full day programs with limited student enrollment

 Thursday  May 22, 2008                                Two Day  Thursday & Friday  May 22-23, 2008

  1^st       2^nd   Choice                                               

___   ___  Elevator Emergencies                          ___   Advanced Extrication* *

___   ___  Engine Company Operations*     

___    ___  Flashover Simulator*

___    ___   Metal Cutting        

*   This workshop requires full PPE,SCBA, spare cylinder and a signed liability waiver

** This workshop is 2 days and requires PPE and a signed liability waiver. See www.pfdsafety.com for more details.

·      NOTES:  A light lunch will be provided for Post-Conference Workshops. Both the Flashover Simulator and the Metal Cutting class

will be held at the Barnstable County fire academy, aprox. 75 from Providence College. Students are responsible for own transportation.

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                                Send Registration Form and make checks payable to:

                                            PFD Safety & Survival Foundation

                                                 274 Reservoir Avenue

                                     Providence , Rhode Island 02907

                                                      www.pfdsafety.com

                                            ( 401 ) 781-3439