Speaker AgreementSpeaker Agreement Meeting Type: * Annual Convention Webinar If known, provide the date of the event you will be speaking at. Presentation Details Proposed Title of Presentation * 10 words or less Presentation Description * This will be included on the MHIMA Annual Convention website, email marketing, and onsite program materials. Learning Objectives * Provide 3-5 learning objectives. What should the participants know, be able to understand, and/or do at the end of your presentation? Speaker Profile * Brief narrative biography. It is used to introduce the presenter at the educational session and may be included in marketing and onsite materials.Speaker Details/NeedsPlease provide as you would want it to appear in print.Presenter Name * Presenter Name Presenter Name Presenter Name Presenter Degree/Credentials Position/Title * Organization Name * Organization Address * Presenter Work Phone * Presenter Cell Phone * Presenter Email * Audiovisual and Other Materials RequirementsThe following items will be set up in each room: podium microphone, lapel microphone (for each session speaker), screen, laptop, and projector. MHIMA will also provide a way for audience members to safely ask questions (either a standing microphone or other technology). Special AV needs will be considered and may be provided (if feasible).Please mark the check-box to request any of the following My presentation has sound. I would like to have the room wired for sound. OtherOtherConflict of Interest DisclosurePlease describe below any relationships, transactions, positions you hold (as owner, director, or volunteer for profit or nonprofit organization) or circumstances that you believe could contribute to an actual or perceived conflict of interest between MHIMA and your personal interest — financial, dual loyalty, or otherwise.CoI I (or my spouse / life partner) sit on the following nonprofit board(s). I (or members of my family am / are an owner, officer, director, or a majority shareholder of the following for profit business(s). List the nonprofit boards. * List the for-profit business. * Registration & Lodging (Applicable to Annual Convention Speakers Only)MHIMA's speaker budget is extremely limited. Convention proposals are generally pro-bono; however, MHIMA is able to offer session presenters the option of a one-day complimentary registration (MHIMA staff will reach out with a promo code to use when completing the online registration form) or complimentary self-parking at the convention hotel for the day of the session(s).Please choose one: * Complimentary one-day registration Complimentary one-day self-parking I am not requesting eitherAgreementI agree to abide by AHIMA and its Component Associations’ Commercial Bias guidelines. (Attachment A)The final PowerPoint presentation must be on the MHIMA template provided. Advertising of the Speakers’ Organization, products, and/or services is prohibited in the presentation. Exhibitors may utilize the Exhibitor booth for that purpose.If providing a recorded session it must be submitted in an mp4 format.I will inform MHIMA within 90 days of my presentation if for any reason, I will be unable to uphold the terms of this agreement. If I am unable to present, I will make every attempt to make suitable arrangements for a qualified replacement on the same topic and notify my MHIMA Program Committee Liaison immediately.I agree and understand that my presentation’s handouts will be shared with registrants. Name * Date * Submit If you are human, leave this field blank. Δ
