2019 Arrowhead EMS Conference & Expo PRESENTATION APPLICATION - - PDF document

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Dec 08, 2022 110 likes •148 views

Page 1 of 3 2019 Arrowhead EMS Conference & Expo PRESENTATION APPLICATION FORM Date: ______________ Please complete one application form for each presentation. INCOMPLETE FORMS WILL NOT BE CONSIDERED Presenter Name: (REQUIRED)

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Page 1 of 3

2019 Arrowhead EMS Conference & Expo

PRESENTATION APPLICATION FORM Date: ______________

Please complete one application form for each presentation. INCOMPLETE FORMS WILL NOT BE CONSIDERED Presenter Name: (REQUIRED) Presentation Title: (REQUIRED) Presentation Phrase (3-5 words): (REQUIRED) Presentation Description: (REQUIRED) Presentation Objectives: (REQUIRED) Target Audience (check all that apply): (REQUIRED) Advanced Life Support CME Basic Life Support Fire Fighter/EMR Pediatric Law Enforcement Medical Director / Physician General

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Page 2 of 3 TO BE CONSIDERED AS A PRESENTER, THIS INFORMATION MUST BE COMPLETED IN ITS ENTIRETY. Name: Credentials: Mailing Address: City: State: Zip: Phone: Fax: Cell Phone: Email: Primary Job Title: Primary Agency Represented: Biographical Description (150 words or less): Presenter Fee/Special Requests (please be specific): Will There Be Co-Presenters/Assistants? O YES Ο NO If yes, complete co-presenter information Will Co-Presenters/Assistants Request Payment? O YES Ο NO Co-Presenter/Assistant Name: Credentials: Mailing Address: City: State: Zip: Phone: Fax: Cell Phone: Email: Primary Job Title: Primary Agency Represented: Biographical Description (150 words or less): Co-Presenter Fee/Special Requests (please be specific):

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Page 3 of 3 Co-Presenter/Assistant Name: Credentials: Mailing Address: City: State: Zip: Phone: Fax: Cell Phone: Email: Primary Job Title: Primary Agency Represented: Biographical Description (150 words or less): Co-Presenter Fee/Special Requests (please be specific): Audio Visual Equipment: All presentation rooms will be provided with:

LCD Projector
Screen
Lavaliere microphone
Lap-top Computer

Additional needs:

AV Equipment:__________________________________________________
Other:_________________________________________________________

For more information contact Sarah:

218-726-0070
sarah@arrowheadems.com

Our Project Coordinator will be in touch with you directly by June 1, 2018 if your proposal has been accepted. If you are selected as a presenter, we will send you a contract to complete and return. Online: www.arrowheadems.com Email: sarah@arrowheadems.com Fax: 218-726-0073 Phone: 218-726-0070 Mail: Arrowhead EMS Association 4219 Enterprise Circle Duluth, MN 55811-5719