Speaker/Moderator Interest Form

Speaker/Moderator Interest Form
If you are interested in speaking or moderating at any of our three conferences, please fill out the information below. If you have any questions, please reach out to info@icphso.org. Your information will be shared with potential proposal proposers. Additionally, your willingness to serve as a potential speaker or moderator will be listed on the ICPHSO website as a resource. By submitting this form, you acknowledge that your contact information will be made publicly available on the website.
Name

First NameLast Name
Email
example@example.com
Phone Number

Country CodeArea CodePhone Number
Organization
Title Position
Are you currently an ICPHSO Member?

YesNo
I am interested in being:

SpeakerModerator (Moderators must be ICPHSO members in good standing at the time of the conference)Speaker & Moderator
Please select which topics you are comfortable speaking about from the list below

Product SafetyRisk ManagementCompliance ManagementChildren's ProductsElectrical Products/BatteriesCybersecuritySupply Chain ManagementInnovative Technologies/Artificial Intelligence/Big DataProduct LiabilityHuman FactorsRecallsSocial Media/MarketingChemical ManagementUS RegulationsInternational RegulationsSustainabilityConsumer Product Test LabOther
Which stakeholder group(s) are you associated with?

ManufacturerRetailerDistributor/ImporterTesting LabRegulatorConsultantAcademiaConsumer RepresentativeParent AdvocateOther
Which event would you be interested in speaking at?

Annual Meeting & Training SymposiumNorth America Product Safety Training WorkshopInternational Symposium
If selected to be a speaker/moderator, I understand that I will be responsible to:
- (MODERATOR ONLY) Ensure that my ICPHSO membership is in good standing.
- (MODERATOR ONLY) Convene with my panel of speakers, provide everyone's headshots/bios, submit our presentation slides, and meet all deadlines.
- (MODERATOR ONLY) Keep the session on track, manage polling/Q&A, and end session on time.
- I will be responsible for all of my event-related expenses (e.g., hotel/travel, registration, meals that are not provided as part of the event).
I agree to adhere to the above responsibilities for my role.

Yes
ICPHSO is committed to ensuring that all participants adhere to fair competition practices in compliance with global antitrust laws. Conference attendees must comply with applicable antitrust laws of the countries where the conference is held, as well as any international or regional laws that may apply. Attendees must avoid discussing completely sensitive topics with competitors at any time in which they are connected for ICPHSO purposes. Any concerns about potential violations should be directed to ICPHSO's Executive Director.
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