Indiana Emergency Nurses Association Annual Symposium

May 5th, 2017, Friday at the Ivy Tech Conference Center, Indianapolis, Indian

Our theme for this year’s symposium is “Gearing Up for Excellence!”

Please complete the following form in order to be considered for the Indiana ENA Annual Symposium.

Speaker Information
Please complete all information below.
Name *
Name
Provide the title you wish to be listed in the program information.
Briefly describe your professional, volunteer, or life experiences and areas of expertise (including publications) that contribute to your particular involvement with this conference or training. This will be used for introductions. Please write in third person and limit your description to 100 words.
Home Address *
Home Address
Area Code and Phone Number- Work *
Area Code and Phone Number- Work
Area Code and Phone Number- Cell *
Area Code and Phone Number- Cell
Presentation Information
The following pertains to your submitted presentation. All information is required to obtain contact hours for our participants.
Length of the Presentation *
Learning Outcomes
Provide at least three learning outcomes for your presentation. They should answer, "Following my presentation, participants will be able to:"
This may be used to promote the event and your presentation. Limit to 50 words.
Presentation Information
Audio/Visual Equipment Needs *
Check all audio/visual equipment that you will need for your presentation(s). If you are involved in more than one session, please specify what equipment will be needed for each session.
If you wish to use your own laptop, you will need to bring appropriate connectors to connect to a projector. HDMI and/or VGA may be used. Select an option below.
Please be specific.