EMS Conference Education Program Submission Question Title * 1. Instructor Last Name OK Question Title * 2. Instructor First Name OK Question Title * 3. Instructor E-mail OK Question Title * 4. Instructor Address (Street # and name) OK Question Title * 5. Instructor Address (City, State, Zip) OK Question Title * 6. Instructor Phone (Best number to use) OK Question Title * 7. Instructor Credentials (EMT, RN, MD, Etc.) OK Question Title * 8. Do you require Assistant Instructors Yes No OK Question Title * 9. If the answer to #8 was yes, please explain why OK Question Title * 10. The conference is scheduled for November 6 - 10. Are there any of these days where you cannot teach? Please list. OK Question Title * 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 OK Question Title * 12. Session 1 Title and Length OK Question Title * 13. Session 1 Brief Description OK Question Title * 14. Session 2 Title and Length OK Question Title * 15. Session 2 Brief Description OK Question Title * 16. Session 3 Title and Length OK Question Title * 17. Session 3 Brief Description OK Question Title * 18. Session 4 Title and Length OK Question Title * 19. Session 4 Brief Description OK Question Title * 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? OK DONE