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Join us on the podium at the 2012 ACDIS Conference

2012 ACDIS Conference Speaker Application

Please complete all of the fields below.

First Name
Last Name
E-mail Address
Phone#
Organization
Address
City
State
Zip Code
 
Please describe your suggested 2012 ACDIS session topic. If you are writing to recommend a colleague or peer as a presenter, please explain why you think this person would be a great addition to the podium.
Please explain why you are qualified to speak on your proposed topic.
Please summarize your background/qualifications in the field of clinical documentation improvement.
Please list any previous speaking or presentation experience.
Please specify whether your topic is intended for a basic, intermediate, or advanced audience.

* All Fields Required

 


If faxing this form, please address the cover page to Brian Murphy's attention.

 

ACDIS: The Association of Clinical Documentation Improvement Specialists.
Phone: 888/639-5900
Fax: 800/639-8511