IHQS Speaker Application Form

Speaker Application Form

This form should be used to submit a proposal to speak at the Innovations in Healthcare Quality and Safety Summit (IHQS).
Speaker Policy

Speakers are required to register for the event. Please note that there will be no speaking honorarium or reimbursement for any expenses; however, a 30% discount on the registration rate will be provided for the speaker.
Acknowledgement*

I understand and accept the Speaker Policy
Email*
example@example.com
Name*

First NameLast Name
Please list your degrees and/or certifications*
Current Institutional Affiliation*
Speaker Bio (brief description of your background and expertise)*

0/200
Proposed Presentation Title*
Brief Synopsis*

0/400
What is the main teaching point(s)?*

0/200
Should be Empty:

Speaker Application Form