2022 AEMSA Conference & Expo Presentation Abstract Submission Form Conference Presentation Application Presentation Title* Presentation Phrase(3-5 Words) Presentation Description*Presentation Objectives*Target Audience Advanced Life Support Basic Life Support Pediatric Medical Director / Physician CME Fire Fighter/EMR Law Enforcement General Add a Second Abstract? Yes Presentation Title* Presentation Phrase(3-5 Words) Presentation Description*Presentation Objectives*Target Audience Advanced Life Support Basic Life Support Pediatric Medical Director / Physician CME Fire Fighter/EMR Law Enforcement General Add a Third Abstract? Yes Presentation Title* Presentation Phrase(3-5 Words) Presentation Description*Presentation Objectives*Target Audience Advanced Life Support Basic Life Support Pediatric Medical Director / Physician CME Fire Fighter/EMR Law Enforcement General The following biographical information must be completed in its entirety for each presenterPresenter's Name* First Last Credentials* Mailing Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Email* Phone*Primary Job Title* Primary Agency Represented* Biographical Description*(1000 characters or less)Presenter Fee / Special Requests*(Please be specific) Will There Be Co-Presenters / Assistants?* Yes No Co-Presenter/Assistant Name:* First Last Will This Co-Presenter / Assistant Request Payment?* Yes No Credentials* Mailing Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Primary Job Title* Biographical Description*(150 words or less)Primary Agency Represented* Co-Presenter Fee / Special Requests*(Please be specific) Add a Second Co-Presenter / Assistant? Yes Co-Presenter/Assistant Name:* First Last Will This Co-Presenter / Assistant Request Payment?* Yes No Credentials* Mailing Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Primary Job Title* Biographical Description*(150 words or less)Primary Agency Represented* Co-Presenter Fee / Special Requests*(Please be specific) All presentation rooms will be provided with: • LCD Projector • Screen • Lavaliere microphone • Lap-top ComputerAdditional Equipment Needs:Additional NotesAre You a Non-Presenter / Organizer Filling This Abstract on Behalf of Another Person? Yes Contact Name* First Last Contact Title* Contact Organization* Contact Email* Contact Phone*E-SignuatureOur Project Coordinator will be in touch with you directly no later than June 30, 2022 if your proposal has been accepted. If you are selected as a presenter, we will send you a contract to sign and return. I acceptNameThis field is for validation purposes and should be left unchanged. Δ
