2024 Missouri EMS Conference & Expo and
Midwest Mobile Integrated Healthcare Forum

Speaker Presentation Proposal

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* 1. Track for Presentation

EMS

Mobile Integrated Healthcare (MIH)

Applies to both EMS / MIH

Other:

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* 2. Presentation Format?

Single Presenter

Panel Presentation (limit 3 panelists)

Interactive Workshop

Other (please specify)

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* 3. Lead Presenter Information

First Name:

Last Name:

Credentials (AA, BS, MD, etc):

Organization Where Employed:

Current Title/Current Position:

Work Address:

Work City:

Work State:

Work Zip Code:

Cell Phone Number:

Preferred Email Address:

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* 4. Lead Presenter Education & Training (If not applicable, put "N/A")

Degree Earned (BA, BS, AS, PhD, MD, etc,):

Year Graduated:

Area of Study:

Name of Institution:

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* 5. Lead Presenter Certiﬁcations, Licensures and Additional Degrees (Please list all certiﬁcations and licensures - If not applicable, put "N/A")

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* 6. Lead Presenter's Biography (maximum of 1000 characters)

Word this EXACTLY as you would like it read when you are introduced for your presentation.

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* 7. Add 2nd Presenter?

Yes

Not Applicable

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* 8. 2nd Presenter Information: (If not applicable, put "N/A")

First Name:

Last Name:

Credentials (AA, BS, MD, etc.)

Organization Where Employed:

Current Title/Current Position:

Work Address:

Work City:

Work State:

Work Zip Code:

Phone Number:

Preferred Email Address:

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* 9. Add 3rd Presenter?

Yes

Not Applicable

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* 10. 3rd Presenter Information: (If not applicable, put "N/A")

First Name:

Last Name:

Credentials (AA, BS, MD, etc.)

Organization Where Employed:

Current Title/Current Position:

Work Address:

Work City:

Work State:

Work Zip Code:

Phone Number:

Preferred Email Address:

All presenters will receive a letter of agreement with requested information for continuing education approval. This must be submitted within the timeframe requested or it is highly likely that the presentation will not be included. The lead presenter is responsible for ensuring that all presenters submit letters of agreement.

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* 11. Presentation Title:

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* 12. Objectives:

List three objectives of your presentation below. Be sure to use measurable objectives. The phrasing "understand" is not measurable.

EXAMPLE: "Identify the processes involved in evaluating the effects of quality improvement programs."

Learning Objective 1: Upon completion of this session, learners will be able to...

Learning Objective 2: Upon completion of this session, learners will be able to...

Learning Objective 3: Upon completion of this session, learners will be able to...

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* 13. 3 Pre/Post Test Questions & Answers:

Provide 3 pre/post test questions and answers that participants will answer prior to your session and following your session to assess if their knowledge of the subject has changed. Be sure this is information that you will cover in your session. Questions can be multiple choice or true/false.

Question 1:

Question 1 Answer Choices:

Question 1 Answer:

Question 2:

Question 2 Answer Choices:

Question 2 Answer:

Question 3:

Question 3 Answer Choices:

Question 3 Answer:

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* 14. Abstract of Presentation (maximum of 2000 characters) For reviewers to use when selecting presentations for the conference.

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* 15. Description for Conference Program (maximum of 400 characters)

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* 16. Select the primary category in which your presentation ﬁts:

Innovation

Leadership

Clinical

Other (please specify)

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* 17. Length of Presentation:

20 Minutes (ideal for EMS lightening rounds) - strict adherence to the 20-minute time frame is required, no exceptions

45 Minutes (ideal for panel presentations with two panelists)

60 Minutes (ideal for panel presentations with three panelists and interactive workshops/hands on sessions)

In order to be selected as a presenter you must agree to the following:

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* 18. I understand that as a presenter submitting through the “Call for Presentations” process all presenters are required to register as a conference attendee. Options are available for one day, two day and full conference.

I agree to register

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* 19. I agree to complete the presenter agreement and Continuing Education forms and submit my Curriculum Vitae (CV), short bio (100 word maximum), publicity photo (jpg, 300 dpi), presentation slides and handouts by the deadlines indicated in the presenter agreement.
ALL SLIDES MUST BE RECEIVED BY THE CONFERENCE PLANNERS PRIOR TO MAY 01, 2024.

I agree

2024 Missouri EMS Conference & Expo andMidwest Mobile Integrated Healthcare ForumSpeaker Presentation Proposal

Question Title

* 1. Track for Presentation

Question Title

* 2. Presentation Format?

Question Title

* 3. Lead Presenter Information

Question Title

* 4. Lead Presenter Education & Training (If not applicable, put "N/A")

Question Title

* 5. Lead Presenter Certiﬁcations, Licensures and Additional Degrees (Please list all certiﬁcations and licensures - If not applicable, put "N/A")

Question Title

* 6. Lead Presenter's Biography (maximum of 1000 characters)Word this EXACTLY as you would like it read when you are introduced for your presentation.

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* 7. Add 2nd Presenter?

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* 8. 2nd Presenter Information: (If not applicable, put "N/A")

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* 9. Add 3rd Presenter?

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* 10. 3rd Presenter Information: (If not applicable, put "N/A")

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* 11. Presentation Title:

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* 12. Objectives:List three objectives of your presentation below. Be sure to use measurable objectives. The phrasing "understand" is not measurable. EXAMPLE: "Identify the processes involved in evaluating the effects of quality improvement programs."

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* 14. Abstract of Presentation (maximum of 2000 characters) For reviewers to use when selecting presentations for the conference.

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* 15. Description for Conference Program (maximum of 400 characters)

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* 16. Select the primary category in which your presentation ﬁts:

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* 17. Length of Presentation:

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* 18. I understand that as a presenter submitting through the “Call for Presentations” process all presenters are required to register as a conference attendee. Options are available for one day, two day and full conference.

Question Title

2024 Missouri EMS Conference & Expo and
Midwest Mobile Integrated Healthcare Forum

Speaker Presentation Proposal

* 6. Lead Presenter's Biography (maximum of 1000 characters)

Word this EXACTLY as you would like it read when you are introduced for your presentation.

* 12. Objectives:

List three objectives of your presentation below. Be sure to use measurable objectives. The phrasing "understand" is not measurable.

EXAMPLE: "Identify the processes involved in evaluating the effects of quality improvement programs."