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2012 Texas EMS Conference Call for Lectures
 
 
Please complete one form for each lecture. Use separate forms for two-hour workshops or preconference classes.
 
 
 
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:  
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.