NJOEMS 2012 Call For Speakers Survey

Thank you for your interest in presenting at the 2012 NJ Statewide Conference on EMS. Each session will be 75 minutes in length (pre-conference sessions must be either 4hr or 8hrs), so please ensure that your presentation is adjusted accordingly. Session selection will take place in April and the speakers will be notified shortly there after. For updated information, please visit the conference website at www.NJEMSConference.com. If you have any questions regarding the Conference, please contact the Office of EMS at (609) 633-7777.

PLEASE NOTE: ALL SUBMISSIONS MUST BE RECEIVED NO LATER THAN FRIDAY, MARCH 30, 2012.

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Primary Speaker Information:

Primary Speaker Information: First Name
Last Name

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Contact Info:

Contact Info: Company:
Address:
Address 2:
City/Town:
State:
ZIP:
Email Address:
Phone Number:

Speaker Credentials

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Presentation Title

Presentation Title

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Please provide a detailed description of your presentation:
(You can cut and paste into this cell from a document if needed.)

Please provide a detailed description of your presentation: (You can cut and paste into this cell from a document if needed.)

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Please provide 3 objectives for your presentation:

Please provide 3 objectives for your presentation: Objective 1:
Objective 2:
Objective 3:

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Primary Speaker Bio:

Primary Speaker Bio:

Co-speaker information (if applicable)

Co-speaker information (if applicable) Name:
Company:
Address:
Address 2:
City/Town:
State:
ZIP:
Email Address:

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Please select which time frame you are interested in presenting

Please select which time frame you are interested in presenting Pre-Conference 4 hour half day session on Nov. 1, 2012

Pre-conference 8 hour full day session on Nov. 1, 2012

General Conference 75 minute session on Nov 2,3, or 4, 2012

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Please select the most appropriate focus for your presentation

Please select the most appropriate focus for your presentation Provider- ALS

Provider - BLS

EMSC (pediatric)

Instructor

Critical Care

Leadership

Emergency Preparedness

Special AV Needs:

Special AV Needs: Computer

Speakers

DVD Player

MAC User (If you are using your MAC computer, please ensure that you can connect to a VGA projector.)

Other (please specify)

Any other requests or comments:

NJOEMS 2012 Call For SpeakersExit this survey

*Primary Speaker Information:

*Contact Info:

Speaker Credentials

*Presentation Title

*Please provide a detailed description of your presentation: (You can cut and paste into this cell from a document if needed.)

*Please provide 3 objectives for your presentation:

*Primary Speaker Bio: