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2022 IHS Virtual Partnership Conference
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2022 IHS Virtual Partnership Conference
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Speaker Registration Form
Speaker Registration Form
*
Mandatory Field
Prefix
Enter Prefix
Mr.
Mrs.
Ms.
Other
First Name
Last Name
Suffix
Job Title
Biography
Session Title 1
Are you the Panel Lead?
Please select
Yes
No
Please add the session abstract
Are you presenting in multiple sessions?
Please select
Yes
No
Session 2 Title
Are you the Panel Lead of Session 2?
Please select
Yes
No
Please add the session abstract of Session 2
Session 3 Title
Are you the Panel Lead of Session 3?
Please select
Yes
No
Please add the session abstract of Session 3
Session 4 Title
Are you the Panel Lead of Session 4?
Please select
Yes
No
Please add the session abstract of Session 4
Session 5 Title
Are you the Panel Lead of Session 5?
Please select
Yes
No
Please add the session abstract of Session 5
Company/Tribe/Organization
Business Address 1
Business Address 2
Business Address 3
City
State
Postal Code
Phone Number
Email
Repeat Email
Registration type
Please select
IHS
Tribal/Tribal Organization
Urban
Other Federal
Other Vendor
Other
Other
If you are a Tribal employee, please indicate the Tribe
IHS Area
Please select
Alaska
Albuquerque
Bemidji
Billings
California
Great Plains
Nashville
Navajo
Oklahoma City
Phoenix
Portland
Tucson
Headquarters
Principal track
Please select
Business Office / Finance
Health Information Management
Information Technology
Purchased/Referred Care
Tribal / Urban
Do you require ADA assistance?
Please select
Yes
No
Sub-categories
Please select
Audio
Visual
Other
Other
Are you attending for AAPC CEUs?
Please select
Yes
No
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