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Questions marked with a * are required
28%
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.
   
 
     |  
If you have any questions please email texasemsconfpresenters@gmail.com.
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