Speaker Bureau Submission Form

If you are interested in speaking, please complete the speaker bureau online submission form below.

By completing the form below, you can let one or more of these associations know that you are interested in conducting a presentation either face-to-face (traditional meeting) or virtually.

If you have any questions, please contact us.

Association That You Wish To Speak*

All

Alabama Health Information Management Association (aahim.org)

Alamo Area Health Information Management Association (alamohima.org)

Alaska Health Information Management Association (akhima.org)

Arizona Health Information Management Association (azhima.org)

Arkansas Health Information Management Association (arhima.org)

California Cancer Registrars Association (ccraregistrars.org)

Cancer Registrars Association of New England (craneweb.org)

Central Pennsylvania Health Information Management Association

Chattanooga Area Health Information Management Association

Chicago Area HIMA

Colorado Health Information Management Association (chima.org)

Eastern Missouri Health Information Management Association

Dallas Fort Worth Health Information Management (dfwhima.org)

Delaware Health Information Management (dehima.org)

Florida Health Information Management Association (fhima.org)

Georgia Health Information Management Association (ghima.org)

Health Information Management Association of Hawaii (himah.org)

Health Information Management Association of New York City (himanyc.org)

Healthcare Quality Professionals of New Jersey (hqpnj.org)

Houston Area Health Information Management Association (hahima.org)

Idaho Health Information Management Association (idhima.org)

Illinois Health Information Management Association (ilhima.org)

Indiana Security and Privacy Network (inspn.org)

Iowa Health Information Management Association (iahima.org)

Kansas Health Information Management Association

Kansas City Health Information Management Association

Kentucky Health Information Management Association (khima.org)

Knoxville Health Information Management Association

Lehigh Valley Health Information Management Association (lvhima.org)

Louisiana Health Information Management Association (lhima.org)

Memphis Health Information Management Association

Michigan Health Information Management Association (mhima.org)

Michigan Cancer Registrars Association (miregistrars.org)

Mid-Missouri Health Information Management Association

Maine Health Information Management Association (mehima.org)

Maryland Health Information Management Association (mdhima.org)

Minnesota Health Information Management Association (mnhima.org)

Mississippi Health Information Management Association (mshima.org)

Missouri Health Information Management Association (mohima.org)

Montana Health Information Management Association (montanahima.net)

Northeastern Pennsylvania Health Information Management Association

Nebraska Health Information Management Association (nhima.org)

Nevada Health Information Management Association (nvhima.org)

New Hampshire Information Management Association (nhhima.org)

New Mexico Health Information Management Association (nmhima.org)

North Carolina Health Information Management Association (nchima.org)

North Dakota Health Information Management Association (ndhima.org)

North Georgia Health Information Management Association

Oklahoma Health Information Management Association (okhima.org)

Oncology Registrars Association of New Jersey (oranjonline.com)

Oregon Health Information Management Association (orhima.org)

Ozark Area Health Information Management Association

Pennsylvania Association of Cancer Registrars (pacr.org)

Pennsylvania Health Information Management Association (phima.org)

South Carolina Health Information Management Association (schima.org)

South Dakota Health Information Management Association (sdhima.org)

Southeastern Pennsylvania Health Information Management Association (sephima.org)

Tennessee Health Information Management Association (thima.org)

Texas Tumor Registrars Association (txtra.org)

Upper East Tennessee Health Information Management Association

Utah Health Information Management Association (uhima.org)

Vermont Health Information Management Association (vthima.org)

Virginia Health Information Management Association (vhima.org)

Washington State Health Information Management Association (wshima.org)

Washington State Tumor Registrars Association (wstra.net)

Western Pennsylvania Health Information Management Association (wphima.org)

West Virginia Health Information Management Association (wvhima.org)

Western Tennessee Health Information Management Association

Wisconsin Health Information Management Association (whima.org)

Wyoming Health Information Management Association (wyhima.org)

OtherOther

First Name*

Last Name*

Credentials

Title

Employer

Address*

City*

State*

Zipcode*

Email Address*

Work Phone*

Cell Phone

Website

Names and email addresses of co-presenters

Brief Bio(s)*

Presenter's Photograph (to be used by Associations as part of the Speaker Bio)

Maximum file size: 2MB

Co-Presenter Photograph (to be used by Associations as part of the Speaker Bio)

Maximum file size: 2MB

About the Presentation

Meeting Type*

Annual Meeting

In-Person (Meeting)

Virtual (Webinar)

Presentation Title*

Presentation Description*

Learning Objectives

List any organizations that have heard your presentation and include the contact person for that organization, along with phone and email.

Topic Area*

Data Structure, Content and Information Governance

Clinical Foundations

Health Law and Compliance

Organizational Management and Leadership

Revenue Cycle Management

Informatics, Analytics and Data Use

Information Protection: Access, Disclosure, Archival, Privacy and Security

Evolving Topics

Other

Unknown

Topic Areas Descriptions

Audio Visual Equipment

AV Needs

Podium microphone

Lapel microphone

Standing microphone in aisle

Wireless handheld microphone

Sound from laptop to room speakers

Internet access

Fees

Speaking Fee*

No Charge

Honorarium Requested

My Company is Sponsoring

Honorarium Fee

Travel Fees

Other Fees

Comments or Questions

Comments/Questions

Speaker Agreement

Click here to review the speaker agreement.

I agree and accept the speaker agreement terms*

I agree and accept

Captcha

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Speaker Bureau Submission Form

About the Presentation

Audio Visual Equipment

Fees

Comments or Questions

Speaker Agreement

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