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?

I am interested in being:

Please select which topics you are comfortable speaking about from the list below

Which stakeholder group(s) are you associated with?

Which event would you be interested in speaking at?

If selected as a speaker or moderator, I understand that I am responsible for:

Moderators only: Maintaining an active ICPHSO membership in good standing.
Moderators only: Coordinating with speakers, collecting headshots and bios, submitting presentation slides, and meeting all deadlines.
Moderators only: Keeping the session on schedule, managing polls and Q&A, and ending on time.
Covering all personal event-related expenses, including registration, travel, hotel, and meals not provided as part of the event.

I agree to adhere to the above responsibilities for my role.

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.