Speaker engagement form

Please fill out the form below as well as the following forms:

–Volunteer form
–Media release form

"*" indicates required fields

Name*

Pronouns*

Please let us know your pronouns

Hidden

CHIMA user ID #

Email address*

Who is your CHIMA contact?*

Organization

Job title

Education credentials, if applicable

(E.g., PhD, BA, MBA)

Professional designations, if applicable

(Eg., CHIM)

Professional biography details

All biography submissions will be edited as per CHIMA’s editorial style guidelines.

High resolution photo

Rather than a selfie, please have someone take a photo of you in front of a solid-coloured wall. The resolution will be much better.

Max. file size: 20 MB.

Website

Social media & handles

E.g., Twitter: @E_CHIMA

Working title of your presentation*

75 characters. Approx. 5-7 words.

Session Abstract*

Please provide a 1-3 sentence summary of your session. All descriptions will be edited as per CHIMA’s editorial style guidelines.

Presentation long description

Please provide a detailed description of your talk that will be placed in a “read more” section on the HIP Week program page. All descriptions will be edited as per CHIMA’s editorial style guidelines.

Supporting information (Select all that apply)

Please indicate the types of supporting information you would like attendees to have access to before your presentation.

Slide deck

Questions for attendees to consider

Videos

Poll questions

How did you hear about the Canadian Health Information Management Association (CHIMA)?*

Other*

CAPTCHA

Please fill out the form below as well as the following forms:–Volunteer form –Media release form

Technical Support

Please fill out the form below as well as the following forms:

–Volunteer form
–Media release form