Speaker RFP Submission Form

• Proposals must be submitted between November 1 - January 31 to be considered for the ANI. Any proposals received after January 31st will be considered for the following year’s ANI or webinars.
• Please check all that apply:
• I Want To Be An ANI Speaker
• I Want To Be A Webinar Speaker
• Please list me in the AAHAM Speaker Database
• Speaker Name: *
• Certification Designations:
• Company Name::
• Job Title:
• Address 1: *
• Address 2:
• City, State Zip: *
• Email: *
• Phone: *
• Phone 2:
• Title: *

  Dr Mr Ms Esq
• *If you have more than one speaker, please include their contact information and biography, etc. separately.
• Session Title: *
• Please provide a clear description of your session. The selection committee is looking for a description that accurately defines the content of your program. The program title should also directly reflect the program’s content. Please make sure the title of your session matches its description and vice versa.
• What are the top five educational outcomes participants will learn from your session?
• Please provide a brief biography of each speaker
• Level of Presentation: *

  Basic
  Intermediate
  Advanced
  
• Which track (for ANI speakers) does your presentation apply to?
• Leadership/Professional Development
  Revenue Cycle Management
  Revenue Integrity/Compliance
  
• Target Audience: *
• Areas of Expertise : *

  AAHAM National	Best Practices	Certification
  Compliance	Denials	Government Relations
  Leadership/Management	Motivational	Niche Reimbursement
  Patient Access	Pricing Transparency	Reimbursement Structures
  Revenue Cycle	Revenue Integrity	Technology

• Where and when have you previously presented this session?
• Type of Presentation: *

  Keynote
  Lecture
  Audience Participation
  Case Study
  Other
  
• If you answered other, please explain:
• Please provide at least two (2) speaking references: Name of Organization, Contact Person, Email, & Phone
• Please submit your outline or entire presentation in Word or PowerPoint format (for Ani speakers) with this application.