Speaker Request for Proposal – form – Texas Society for Respiratory Care.

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Chartered Affiliate of the American Association for Respiratory Care

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Chartered Affiliate of the American Association for Respiratory Care

Name*
First Last
Headshot*
Accepted file types: jpg, png, gif, pdf, Max. file size: 64 MB.
Please upload a photo of your face that we can use in our promotional publications, brochures, etc.
Education Credentials*
- AA
- AAS
- AS
- BA
- BHS
- BS
- BSEd
- BSN
- BSRC
- BSRT
- DHSc
- EdD
- JD
- MA
- MBA
- MEd
- MHA
- MHS
- MPA
- MPH
- MS
- MSEd
- MRC
- MSRC
- MSA
- MSJ
- MSN
- PhD
- Other
Credentials*
- AE-C
- CPFT
- CRT
- CRT-NPS
- CRT-SDS
- CSE
- CTTS
- DO
- EMT-P
- LPN
- LVN
- MD
- RN
- RPFT
- RPSGT
- RRT
- RRT-ACCS
- RRT-NPS
- RRT-SDS
- Other
Home Address*
Street Address Address Line 2 City State ZIP Code
Email*
Enter Email Confirm Email
Home or Cell Phone*
Employment Title
Place of Employment*
Work Address*
Street Address Address Line 2 City State ZIP Code
Work Phone*
What section best describes the area of interest of this presentation?*
Will you need access to the internet for your presentation?*
- Yes
- No
Have you ever presented this information on a state or national level before?*
- Yes
- No
Will you be sponsored for travel, hotel, meals or honorarium by an industrial affiliate?*
- Yes
- No
If "Yes", who will be sponsoring and describe the sponsorship*
Presentation Title*
List three (3) objectives for your presentation.*
Give a brief, 3-4 sentence summary of this presentation*
Is there any direct or perceived industrial bias within your presentation or on the slide deck?*
- Yes
- No
Please submit a brief 3-4 sentence narrative of how you are qualified to present this information*
Please provide a 3-4 sentence introduction to be used if your presentation is selected*
Name
This field is for validation purposes and should be left unchanged.

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Recent News

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About the TSRC
Regional News
Government Affairs
Education
- Continuing Education for Respiratory Therapists (CERT) Program
Professional Resources
Employment
- Career Center
- Employer Job Listing Application
News
Elections
ARCHIVES
Regions
State Convention
- 2023 TSRC State Convention Information

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