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Questions marked with a * are required
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 *
If yes, co-presenter(s) name(s)
Will co-presenter(s) be paid?
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:  
      State:         Zip:    
Email Address:  
Assistants, if any, for nametags. Assistants are not paid an honorarium.
If you have any questions please email texasemsconfpresenters@gmail.com.