Houston HIMSS Chapter Speaker Request Form
RequiredRequired Question(s)
Required 1.
Speaker Information:

First Name:
Last Name:
Job Title:
Company Name:
Work Phone:
Email Address:
Postal Code:

Required 2.

Provide a brief speaker bio:


1000 characters left.
Required 3.
Will there be a co-presenter? If yes, please provide their name, title, email address and a brief bio. 

1000 characters left.
Required 4.

Presentation Topic: (select one)

Interoperability & Health Information Exchanges
Medical Informatics / EHR
Health IT Project Management
Mobile Health / Wearable Technologies / RTLS
Telehealth / Telemedicine
Clinical & Business Intelligence / Modeling
Health IT Policy
Blockchain: The Next Frontier in Healthcare Innovation
Privacy & Security
Quality and Patient Safety
Professional Development
Required 5.

Presentation Title


350 characters left.
Required 6.

Session Description:  Give us a brief abstract  (limit to 1000 characters)


Selection criteria:
1. Topic should be relevant to the healthcare audience and preferably should help bring some new perspective
2. It should be non-commercial and have educational value
3. Speaker should have experience and expertise in that particular topic
4. It shouldn't be a repetition of a recent presentation (case by case)


1000 characters left.
Required 7.

Please list three or four learning objectives the audience will take away from your talk.


350 characters left.
Required 8.

Please indicate when you will be available to give this talk at a Houston HIMSS Lunch and Learn or other event.  See this link.  Most of the time, the lunch and learn dates without a speaker indicates we need that slot filled by someone.


This is not true all of the time though.  Please give us a list of months that you would like to speak. If you can speak anytime, please indicate that.


350 characters left.
Required 9.

Have you presented this same presentation before? If so, please leave the event and date below in the comments field. 

  • Comment:

  • 500 characters left.

If you have a link to a recent head shot of yours, please paste the hyper-link below. (i.e. LinkedIn, Twitter) Otherwise, someone will reach out to you via email to provide a picture if selected.


350 characters left.