Faculty Application - WCICON21
Please fill out each question as best you can. Most of them are required. The more you leave blank, the less likely you are to be selected as a speaker. There has been a great deal of interest in speaking at the conference, so choosing speakers will unfortunately be a competitive process. The following factors will all have significant impact on whether you are selected as a speaker or not: Requests from potential attendees for you and your topics, the number of talks you are willing to give/panels you are willing to moderate, whether your talk(s)/panel qualifies for CME, prior experience, and your topic(s).

Please submit a separate form for each potential presentation or panel discussion.
What is your name? *
What is your email address? *
What is your phone number? *
Which airport would you be flying out of to get to Phoenix? *
Why should you be selected as a speaker? (Include a paragraph +/- links to prior speaking engagements/videos) *
Are you willing to provide a copy of your slides to attendees (as part of an online course)? (Note: A "no" answer will likely result in you not being invited to be part of the faculty) *
If it is not possible to do the live conference (because of Covid-19 concerns), are you willing to record an online talk to be used in a virtual conference and/or online course? *
The conference will be packaged up into an online course afterward including your video images, audio, and slides for which there will be no additional compensation beyond the speaker fee. Will this be acceptable to you? (Note: A "no" answer will likely result in you not being invited to be part of the faculty) *
This year we are going to have 3 different tracks at our conference. Which of the following tracks would your presentation best fit into? *
What is the title of your presentation/panel? *
Please describe the content of your presentation/panel discussion in one paragraph *
List five objectives of your presentation/panel discussion *
If a panel discussion, suggest possible panel members
What other speakers should we consider inviting to speak?
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