PAMED Speaking Engagement Request Form

PAMED Speaking Engagement Request Form
Thank you for your inquiry regarding speaker requests.

To ensure optimal planning and coordination, we kindly ask that all requests be submitted no less than six weeks in advance of the event. A PAMED staff member will reach out to you within 7 days of your request.
Event/Meeting Basics
Title of Event/Meeting
Event/Meeting Start Date & Time

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Hour MinutesAM/PM Option
Event/Meeting End Date & Time

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Hour MinutesAM/PM Option
Speaker to RSVP By:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Event Location
If meeting link is not available, please put "Link will be forthcoming"
Link
If meeting link is not available, please put "Link will be forthcoming"
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Group/Organization/Hospital Name
Type of Attendees

Other
Special Attendees
Please list any attendees that the speaker should be aware of

Point of Contact
Name

First NameLast Name
Title
Email
example@example.com
Cell Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Event/Meeting Materials
Are handouts expected/welcomed?
Is use of a PowerPoint appropriate?
What date do you need the slides by?

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Do you need any materials from PAMED to assist in the event/meeting?

Other
What date do you need the materials by?

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty:

Event/Meeting Basics