Chapter Speakers

Please tell us about yourself.

Begin by letting us know a little about yourself. When you have completed this section, please continue by selecting the next tab in the top row, or by clicking "next" at the bottom of the form. Please note that fields marked with * are required.

Prefix: *   First Name: *   Last Name: *  

Job Title:    Employer:   

Phone: *   Alt. Phone:   

Email address: *  

City: *   State / Province: *   Country: *  

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Speaking to your local chapter

Please provide a general idea of how far you might be willing to travel to speak to your local chapter, as well as when you might be available to do so. While this information is not required, it does help chapter officers plan their event calendars and reserve venues.

Fields marked with * are required.

Travel radius: *  

Please select the months you may be available to speak.

January    February    March    April   
May    June    July    August   
September    October    November    December   

If you prefer, you can select a range of dates for which you might be available to speak.

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Speaking to a second chapter

If you will be travelling or at another location and would like to speak to the chapter in that area, please provide a general idea of the location you'll be, as well as when you might be available to speak.

City:    State / Province:    Country:   

Please select the months you may be available to speak to a second chapter.

January    February    March    April   
May    June    July    August   
September    October    November    December   

If you prefer, you can select a range of dates for which you might be available to speak to a second chapter.

   < From    |    To >

    Previous | Next

Speaking to a third chapter

Thank you for adding another chapter you'd be available to speak to. We appreciate your willingness to support our members! Please note below the location and dates you will be available.

City:    State / Province:    Country:   

Please select the months you may be available to speak.

January    February    March    April   
May    June    July    August   
September    October    November    December   

If you prefer, you can select a range of dates for which you might be available to speak.

   < From    |    To >

Previous | Next

Please provide some general information on a topic you would like to present, or your areas of expertise.

Topic 1: *  

Topic 2:   

Topic 3:   

If you have a biography, CV or other materials, you may upload them as part of your entry. Please note! At this time,
we are only able to accept files in PDF and Microsoft Word formats.

File to upload:   

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Thank you very much! Your willingness to support our chapters is greatly appreciated. Please note that your information will only be made available to AHS event and chapter personnel. If you do have any questions, please feel free to contact Liz Malleck, AHS Director of Membership.

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