Audio Seminar/Webinar Faculty Application Form

 

Please complete this form indicating titles you would like to be considered for and/or topics you would like to propose. We also would like a short bio highlighting why you are qualified to present a continuing education seminar.

When you are finished, click the "Next" button.

BLUE highlight areas indicate required fields..

PART 1: Your Information      
Current Name      
First
 MI
 Last
Credentials
 
Job Title
 Organization
   Are you an AHIMA member?
Yes   No 		   
Address      
Street
City
 State
 Zip Code
  
Contact Information      
Daytime Area Code and Phone Number
  		E-mail Address
    
   
PART 2: Seminar Titles  
Seminar titles I would be available to present (refer to the list of 2008 audio seminars)
  
DATE SEMINAR TITLE  

 

 
 
PART 3: Seminar Topics  
Seminar topics I would like to propose
  
SEMINAR TOPICS
Please provide a brief description for each topic idea.		  
 
 
 
   
Biography - 1 or 2 paragraphs emphasizing why you are qualified to present a program on this topic.