First Name
Last Name
Your address
Virginia EMS Certification # (if applicable)
Virginia EMS Educator Certification # (if applicable)
Certification Level (if applicable)
If other, please provide certification or licensure level
Brief Biography
Upload a resume' or curriculum vitae
Please complete a separate submission for each presentation
Presentation Title
Presentation Description
Presentation Length (All presentations on 11/15 and 11/16 should not be more than 2 hours in length, if possible)
Objectives (minimum of 3)
Special Equipment needs, room layout or requests?
Maximum Number of Students
Additional Instructors Needed (list full name, email address and phone number)
Pre-Requisites
Date(s) Available to Present (Merit Badge & pre-conference courses will be held on 11/13 and 11/14 ONLY)
Additional Request/Comments