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EMS Conference Education Program Submission
1.
Instructor Last Name
2.
Instructor First Name
3.
Instructor E-mail
4.
Instructor Address (Street # and name)
5.
Instructor Address (City, State, Zip)
6.
Instructor Phone (Best number to use)
7.
Instructor Credentials (EMT, RN, MD, Etc.)
8.
Do you require Assistant Instructors
Yes
No
9.
If the answer to #8 was yes, please explain why
10.
The conference is scheduled for November 6 - 10. Are there any of these days where you cannot teach? Please list.
11.
Available time lengths for the preconference are 4 hours and 8 hours, and the regular conference sessions are scheduled in 1-hour blocks. How many sessions are you submitting? Please indicate how many 4-hour, 8-hour, and 1-hour sessions you are submitting.
4-hour preconference sessions
8-hour preconference sessions
1-hour conference sessions
12.
Session 1 Title and Length
13.
Session 1 Brief Description
14.
Session 2 Title and Length
15.
Session 2 Brief Description
16.
Session 3 Title and Length
17.
Session 3 Brief Description
18.
Session 4 Title and Length
19.
Session 4 Brief Description
20.
We typically provide Instructors with a hotel room either the night before or after their session(s), free attendance to any other program at the conference (except for any certification fees or books), and a banquet ticket. Do you require any other honorarium for presenting at the conference?
Yes
No
If yes, how much?
Current Progress,
0 of 20 answered