IAPA Speaker Request Form - Idaho Academy of PAs

IAPA Speaker Request Form

Would you like to be considered as a speaker for an upcoming IAPA event? Please fill out the form below and we will be in touch if we feel you would be a good fit. Thank you!

First Name *
Last Name *
Organization
Professional Title
Email Address *
Phone *
Website URL
Example topics and titles you speak about *
Fees you typically charge for a lecture (per hour, honorarium, travel/lodging) *
Why are you interested in speaking for IAPA? *
Do you have any relevant financial relationships that would need to be disclosed? *During the CME accreditation process, all relevant financial relationships need to be disclosed in order to obtain CME credit for our attendees. Depending on the financial relationship, it could prohibit from speaking at one of our events. Please contact us if you have any questions.
Do you require that we arrange, and cover, travel expenses?
How far advance do you usually book up?
Any information not included above?
Any additional comments?

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