<p> 2018 Les Lukert Winter Conference Presentation Proposal Form</p><p>Contact Information for Presenter </p><p>Name: ______Title:______Agency/Company: ______Address:______City:______State:_____ Zip: ______Phone:______Cell: ______Email address: ______Presentation Information</p><p>1. Title of Presentation: ______Please provide a 50 word descriptive overview of your presentation suitable for use in Conference advertising. ______</p><p>______</p><p>______</p><p>*The NSFSI Conference Planning Committee reserves the right to amend workshop titles & descriptions.</p><p>2. Have you ever taught the proposed presentation at another conference? If yes where? ______</p><p>3. Please provide contact information from other conferences you have presented at</p><p>______</p><p>______4. Style of Presentation:  Interactive Lecture Hands On Training</p><p>5. Preferred length of presentation:</p><p>12 hours (1 co-speaker allowed for classroom and 2 for Hands On Training, contact information, </p><p> and bios of both presenters must be included) 8 hours (1 co-speaker allowed; contact information, and bios of both presenters must be included)</p><p>4 hours (single speaker)</p><p>7-8 hours (single speaker) Friday Pre-Conference Instructor Professional Development Class</p><p>7-8 hours (single speaker) Friday Pre-Conference H.O.T. Class</p><p>6. Please include your minimum and maximum numbers of students. Minimum_____ Maximum ______</p><p>7. Additional Speakers: (Names and Titles please) 1. Name: Title: Email address: 2. Name: Title: Email address: </p><p>8. Target Audience: (Please check all that apply)  Instructors/Training Officers   Firefighters  Fire Chiefs   Chief Officer  Other, please list (i.e. Hazmat, </p><p> Company officers Rescue, EMS, etc.) 9. Audio/Visual Equipment: Please check one of the following: (Screens, wireless internet, sound system are provided)  No AV equipment needed I will provide my own AV equipment. </p><p> I will need the following AV equipment provided for me:</p><p> Projector  Name tent style cards</p><p> Flip Chart and Markers  Lectern/podium</p><p> Laptop Computer  Other: speakers / sound</p><p> Lavaliere microphone  Other: </p><p> Other: </p><p>10. Biography: Please include a brief 35 word biography in paragraph form for EACH speaker written in third person suitable for use in conference advertising. </p><p> ______</p><p> ______</p><p> ______</p><p> ______</p><p>  11. How would you categorize your class (check which apply):  Leadership  HazMat</p><p> Strategy and Tactics  Instructional Methodology  Technical Rescue  EMS for Instructors</p><p> Wildland  Health , Safety and Survival</p><p> EMS for Providers  Other (Explain)______</p><p> ______12. Would you consider doing a keynote speech for the Saturday Evening Leadership Banquet?  If yes, please provide topic and or summary. ______ ______ ______</p><p> Items requested if proposal is accepted for presentation:</p><p>- Electronic copy of presentation or handouts - Digital photo of each presenter – must be in jpg format with a minimum 300 dpi quality - A short video describing the presentation to use to promote conference and presentation</p><p></p><p></p><p>  Any questions can be directed to Tim Linke via email at [email protected] </p><p> </p>