Speaker Submission Form

Contact Information:

First Name:
Last Name:
Title:
Company Name:
E-Mail:
Phone:

Speaker Subject Areas: (check all that apply)
Patient Safety
Information Technology
Business & Management
Technical Operations and Support
Imaging
Other: Please describe below:
Note: Please provide specific topics on which you can speak in your biography submission (below).

Biography: Cut and paste your biography here. Please note if you would request travel expenses to be covered.

Regions: Check any regions to which you are willing and able to travel (check all that apply).
Northeast
Mid Atlantic
South
Midwest
Southwest
West
Note:If you are only willing and able to travel to a specific state, please include this in your biography.

Terms and Conditions Agreement:
The Speaker Clearing House is meant to serve as a resource for local biomedical and clinical engineering organizations in search of presenters for local meetings. AAMI does not represent the local organization or the speakers involved. Any agreements entered into are between the speaker and the local organization. Individuals and organizations who use this service agree to indemnify and hold AAMI harmless in any disputes that may arise. Submission of this form constitutes your agreement to these terms and conditions.