Conference Sponsors
Organizing body

Call For Speakers Application

The 18th Annual Healthcare Internet Conference is currently seeking speaker proposals. If you are interested in speaking, please submit your proposal no later than 5pm on Friday, March 7, 2014.  Please complete all fields in this form (co-presenter information is optional) before submitting the application by hitting the “send” button at the bottom of the form.
Is this proposal for*:

Primary Presenter contact information:

limit text to 75 words

Co-Presenter contact information: (optional)

limit text to 75 words

Session information:

Presentation Category* (please select the category you feel best fits your presentation)

limit to 75 words

Three learning objectives*:

Use this space for any additional information that you feel may be valuable for the selection committee. Limit to 100 words.
Would you be interested in presenting this topic in our HCIC: Backstage Pass webinar series?

Select choices
Select choices
If the proposal is accepted, I agree on behalf of myself and any co-presenter to meet all deadlines by the conference sponsors. I agree not to change content or presenters without the express written consent of the sponsors. I understand that I am responsible for all costs of presentation, including travel, hotel and per diem. I agree to stay at the Westin Kierland Resort & Spa. I grant the conference sponsor the right to audiotape, distribute and/or post online the presentation and handout, for profit or otherwise. 
Have you given, or will you be giving, this presentation at another educational conference?