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Speakers Bureau Description

In an attempt to identify qualified speakers for educational programming, the FSHP Educational Affairs Council has developed a Speakers Bureau. If you are a member or friend of FSHP and interested in being listed on the Speakers Bureau, please complete this online application, and upload your CV. Please note that your submission does not guarantee a speaking engagement. At this time, we ARE NOT accepting applications from pharmacy students, residents, or fellows. Data will be retained for a rolling three-year period to ensure current information is available to FSHP Councils.

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* 1. First Name

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* 2. Last Name

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* 3. Preferred email address

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* 4. Alternate email address

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* 5. City

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* 6. Preferred Phone Number

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* 7. Birth Year

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* 8. What is your race or ethnicity?

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* 9. Place of Employment (please fully spell out facility, institution, etc.)

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* 10. Job Title

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* 11. Practice Area

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* 12. Years of Experience in Practice Area

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* 13. FSHP Member

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* 14. Select topics you are experienced in presenting on

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* 15. Highest level of speaking experience

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* 16. Willing to travel

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* 17. Upload CV

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.
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* 18. Speaking Interests

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