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AAPA Speaker Request Form

Submit this form to request a visit by an AAPA Board member (including the CEO) or other volunteer leader (e.g. committee chairperson). Please submit requests at least 12 weeks in advance of the desired event date to ensure time for appropriate review and planning. The form is designed to capture as much information as possible to inform the decision-making process; however, you may be contacted for additional information. A staff member will reply to your request as soon as possible. 

Requests for a staff member to speak may be sent directly to the staff member. A staff directory is available on the AAPA website.

Please contact governance@aapa.org with questions or if you require assistance. Thank you.

Basic Information

Presentation Information

Preferred presenter (Speaker is determined based on availability and topic). *
 
Preferred presentation topic *
 
Type of presentation *
 
 +
Do you have any flexibility if this date is unavailable? (please add brief detail) *
 
Do you want to include audience Q&A? *
 
Will you be applying for CME credit for this session? *
Type of attendees expected (please check all that apply) *
 
Are you inviting any AAPA staff to this event? *
 

Speaker Logistics

What information does the host organization need? *
Does the speaker need to be registered for the event? *
Is the host organization funding the speaker's travel? *
Is the host organization funding the speaker's accommodations? *

Additional Opportunities

AAPA looks at each invitation to speak as an opportunity to fully engage with PAs, students, healthcare leaders and other stakeholders. Therefore, we encourage opportunities for AAPA speakers to engage beyond the primary speaking request. This section aims to explore what additional opportunities may be available.  
Do you anticipate media coverage at this event? *
What opportunities are available to meet with your organization's leadership? *
What other opportunities are you interested in exploring? *
 

What Did We Miss?

Thank you for your request.