Apply to be a WIH speaker - Women in Healthcare

Name*

First Last

Please include first, last and any credentials that should be included.

Title*

Organization*

Company Logo*

Drop files here or

Accepted file types: jpg, gif, png, Max. file size: 2 MB, Max. files: 3.

Company Overview*

Your company elevator speech in 50 words or less.

Email*

Phone*

Address*

Street Address Address Line 2 City State ZIP Code

Website

Head Shot*

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Accepted file types: jpg, gif, png, Max. file size: 2 MB, Max. files: 2.

Bio*

Would your organization be interested in sponsorship of this webinar?*

Yes
No

Name of Presentation*

Date of Presentation

WIH Tracks*

Select All
Healthcare Education
Professional Development
Mentorship
Self
Community

Please select the WIH track your presentation will cover.

Presentation Overview/Description*

In 50 words on less, provide your presentation teaser.

Presentation Abstract*

Accepted file types: doc, pdf, Max. file size: 2 MB.

Please upload a brief abstract explaining your presentation with a list of lessons learned for the attendees.

Does your presentation offer CEUs?*

Yes
No

If Yes, Which?

Will you be submitting an article?*

Yes
No

Articles are used as teasers in the WIH newsletter and social media that give a taste of what the presentation will look like. This should cover some area of your presentation and leave your audience wanting to hear more. Articles are due 30 days prior to your presentation.

Consent*

Agreement

By checking this box I acknowledge entering into an agreement between myself and Women in Healthcare, Inc. to present the above mentioned topic at the above mentioned date.

For purposes of planning, the Speaker(s) agree to the following terms and conditions:
1. The Speaker(s) agree to submit their webinar title and 100-word description to ED by email, as soon as reasonably possible, but no later than 45 days prior to allow sufficient time to publicize the event.
2. The Speaker(s) agree to participate in a Webinar logistics call with board point of contact one (1) week prior to the Webinar Date. Board member will schedule the call with Speaker(s) by email.
3. The Speaker(s) authorize WIH to record the Webinar and to publish the Webinar handout materials on the WIH website in the password-protected “Members Only” section.

Speaker Information Form