ASHRM Speaker Request Form Welcome ASHRM is pleased to support your event by providing a member of the ASHRM Board or ASHRM staff to speak at your event. ASHRM wants to help chapters and organizations provide important, timely, and relevant information in the field of health care risk management. ASHRM Staff and Board members have the expertise needed to provide this information and add value to your meetings and conferences.To request an ASHRM speaker, please fill out the request form below and provide as much information as possible about the event. Note: This form does not guarantee the availability of the speaker. Question Title * CHAPTER OR ORGANIZATION NAME Question Title * CONTACT INFORMATION Your Name Position Held in Chapter or Organization Your Phone Number Your Email Address Question Title * EVENT INFORMATION Title of Event Date(s) of Event Time of Presentation Length of Presentation Venue/Location of Event (Please provide the Venue's location, address, city, and state) Please Provide Any Other Information Regarding the Event Question Title * EXPECTED ATTENDANCE 0-25 25-50 51-100 101-150 151-250 250+ Question Title * ASHRM AVAILABLE SPEAKER TOPICS ASHRM Update Customized Content (customized content request will be reviewed, but can't be guaranteed) ASHRM Update •Fee—Free upon request•Expenses—ASHRM will cover speaker travel and accommodationsCustomized Content•Fee – quote will be provided – explain custom content request below in additional comments•Expenses – Speaker travel and accommodations paid by chapter or organization Question Title * Please provide details of the customized content you would like Submit