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* 1. Please complete the following contact information:

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* 2. Please provide your total number of years of EMS experience.

The remaining questions provide an idea of your interests in learning about the EMS leadership topics. Please complete the following questions in order to help facilitate a learning environment that coincides with the needs of the attendees.

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* 3. Please rate your interest in learning about the EMS Advisory Council and Constituency Groups.

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* 4. Please rate your interest in learning about EMS leadership strategic planning.

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* 5. Please rate your interest in learning about EMS grant opportunities.

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* 6. Please rate your interest in learning about purchasing decisions for the EMS leader.

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* 7. Please rate your interest in learning about EMS reimbursements issues for the EMS leader.

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* 8. Please rate your interest in learning about EMS community integration.

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* 9. Please rate your interest in learning about Patient and Provider Safety EMS Risk Management.

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* 10. Please rate your interest in learning about EMS human resource issues.

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* 11. Please rate your interest in learning about EMS public relations.

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* 12. Please rate your interest in learning about EMS education and EMS continuing education.

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* 13. Please rate your interest in learning about EMS disaster response.

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* 14. Please rate your interest in learning about EMS medical direction.

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* 15. Please rate your interest in learning about EMS data systems.

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* 16. Please rate your interest in learning about time sensitive diagnoses systems of care (i.e. trauma, STEMI, stroke).

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* 17. Please rate your interest in learning about EMS system quality improvement.

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* 18. Please rate your interest in learning about Florida EMS regulatory environment.

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