Trucking Summit Delegate Application

Please complete the below form to apply for the Summit. Make sure to complete the entire form and then click the blue "Continue" button. Please feel free to call Katie Sieracki at 847-423-2991 with any questions. We look forward to reviewing your application!

Event: 2020 EMS Virtual Summit
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Please tell us about your organization:

Tell us a little about yourself - your background, years in the industry and your current scope of responsibility. Hunter, fisherman or muscle car enthusiast? Tell us that too!

Tell us a little bit about your department (2-5 sentences).

What is the population size that your department serves?

How many EMTs and/or Paramedics are in your department?

Is your department a transporting agency?

How many Advanced Life Support (ALS) ambulances does your department own and operate?

How many Basic Life Support (BLS) ambulances does your department own and operate?

What do you think your department is doing well right now?

What keeps you up at night regarding your department?

If you could ask a room full of your peers a question or two about their operations, what would those be?

What other EMS Chiefs or EMS departments would you recommend we include in the Summit?


PROCUREMENT PLANS:

Please list 2-5 products or technologies you're interested in learning more about:

What is your annual department budget?

Are you responsible for the selection or recommendation of products and services for your department?

New ALS ambulances: What is your department’s projected need?

New BLS ambulances: What is your department’s projected need?

Communications/Dispatch equipment: What is your department’s projected need?

Incident management and accountability systems: What is your department’s projected need?

Facility equipment and management: What is your department’s projected need?

Apparel/Uniforms: What is your department’s projected need?

Airway and respiratory products: What is your department’s projected need?

EMS billing services and technology: What is your department’s projected need?

Diagnostic medical equipment: What is your department’s projected need?

Health and Wellness programs: What is your department's projected need?

I Agree: If I am selected to participate in the EMS Virtual Summit, I agree to be present for all online sessions, meetings and functions scheduled for the event.

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Please only click the "continue" button once. The application will take a moment to process your responses.