Call For Speakers Application

Submitter Contact Information: *
Please make sure this information is complete and accurate.*

Primary Presenter contact information: (NOTE: if primary speaker is a vendor, there must be a provider or client co-presenter)

Co-Presenter contact information: (Note: A co-presenter is optional unless the primary speaker is a vendor)

Session information:

Is this proposal for*:

Are you willing to do a pre-recorded session for inclusion in the mobile app if we are unable to fit the session into the live conference?*:

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.
Have you given, or will you be giving, this presentation at another educational conference?*



Speaker Release Form*

If the proposal is accepted, I agree on behalf of myself and any co-presenter to provide an electronic copy of the presentation (PPT deck) to the HCIC staff by Monday, October 16, 2023 for inclusion in promotional materials, the conference mobile app, and the website. In the absence of timely materials, HCIC may decide to withdraw my presentation.

I and my co-presenters understand and respect the professional nature of HCIC and will refrain from overt statements, harsh language, or pointed humor that disparages the rightful dignity and social equity of any individual or group. Speakers should embrace a communication style that is sensitive to differences in gender, race, age, religion, politics and abilities. Speakers should avoid making generalizations or assumptions.

I and my co-presenters agree not to change the title or topic of content or presenters without the express consent of the organizers. I understand that I am responsible for all costs of presentation, including travel, hotel, per diem and fee for attending.

I agree to stay at the JW Marriott Los Angeles L.A. Live in Los Angeles, CA.

I hereby grant and release to Greystone.Net (“Greystone”), its successors, assigns, and licensees (“Greystone and its agents”) the right to record myself and my co-presenters' entire presentation, including our likeness, voice and verbal statements, on film, videotape, and audiotape (collectively, the “Recording”) . I also grant Greystone the right to edit, distribute and/or sell the Recording, alone or as part of a compilation, at its discretion without additional approval from me or compensation to me. Nothing in this Agreement constitutes an affirmative obligation on the part of Greystone to distribute the recording.

I further grant to Greystone and its agents the right to use the Recording, my name, likeness, voice, and biographical information and any other information about me in connection with the advertising, promotion and public relation efforts relating to the conference in any and all media, now known or hereafter created without any compensation to me.

I hereby grant to Greystone the right to reproduce and repurpose any printed materials and electronic materials prepared by me for the conference without compensation to me. 

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