EMS360 Speaker Application
EMS360 will be here sooner than we think! The dates are January 21st and January 22nd, 2027. Apply to be a speaker at EMS360. Please provide your details, session topics, and preferences below.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Company Name (if applicable)
Professional Title/Credentials
*
Presentation Title(s) or Topic(s)
*
Topic Category
*
Leadership
Clinical Care
Trauma
Airway / Critical Care
Operations
Mental Health / Wellness
EMS Education
Case Review
Other
Speaker Background / Brief Bio
*
Headshot (optional, but helpful for advertising)
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Preferred Presentation Length
*
30 minutes
60 minutes
No preference
Preferred Date to Speak
*
21st
22nd
No preference
Do you require an honorarium?
*
Yes
No
If yes, please specify the honorarium amount requested:
Do you require travel reimbursement?
*
Yes
No
If yes, which travel expenses apply? (Select all that apply)
Air fare
Rental car
Hotel
Other
Note: Lodging options will be sent out closer to the date.
How many lecture spots would you like to have?
*
Would you be interested in participating in a panel discussion or collaboration if not selected for a solo presentation?
*
Yes
No
Maybe
Submit Application
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