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2012 Texas EMS Conference Call for Preconference
 
Please complete one form for each preconference class. Use separate forms for two-hour workshops or one-hour lectures.
 
 
Section 1: Presenter(s)
 
 
Presenter *
 
 
Co-presenter *
 
Yes
 
No
 
If yes, co-presenter(s) name(s)
 
 
Will co-presenter(s) be paid?
 
Yes
 
No
 
Contact Information
Company Name/Address 1 * :
Address 2    :
City * :
    State * :       Zip * :  
Phone * :
Email Address * :
 
In order to ensure that we are able to reach you for any changes/updates during conference, please provide a cell number or alternate email address.
Cell Phone :
Alternate Email Address :
 
Contact Information for Co-presenter
Address 1 :
Address 2 :
City :
    State :       Zip :  
Phone :
Email Address :
 
Assistants, if any, for nametags. Assistants are not paid an honorarium.
 
 
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If you have any questions please email texasemsconfpresenters@gmail.com.