General Meeting Speaker Interest Form

This form is for those interested in speaking or sponsoring a specific speaker to speak at an APIC MN general meeting. The APIC MN Education Committee will review your submission and let you know if we can accommodate your presentation. Due to the limited number of meetings per year we may need to plan more than a year in advance for topics.

Speaker Name

Speaker Email Address

Speaker Phone Number

Speaker Organization/Affiliation(s)

Presentation Title/Topic

Presentation Description and Objectives

Speaker Conflicts of Interest (if applicable)