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SHIMA Speaker Interest Form
Thank you for your interest in speaking with the Seattle Health Information Management Association!
Please complete this form and a board member will reach out to you.
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* Indicates required question
Speaker First and Last Name
*
Your answer
Contact Information
Phone Number and Email
*
Your answer
Please indicate if you are currently credentialed through AHIMA
*
Yes
No
Select when you would prefer to speak this year.
*
First Quarter (January - March)
Second Quarter (April - June)
Third Quarter (July - September)
Fourth Quarter (October - December)
Open to speak anytime during the year
Please indicate your speaker presentation preference.
*
Online/Virtual
In person
No preference
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