2021 Health and Safety Summit Speaker Form
Thank you for your interest speaking at the 2021 Arizona Health and Safety Summit March 17-19. This is a voluntary virtual speaking engagement. Proceeds from our summit are used for local scholarships, professional development, and activities for Health/Safety professionals of Arizona.

Please fill in the fields below so we can capture your information. Deadline for submissions is December 7, 2020. Our speaker selection process will conclude by the end of the year.

If you have any questions, please email Christopher Brandon at presidentelect@az.assp.org. Thank you!
What is your name? *
What is your email address? *
What is your cell number? *
What aspect of Health & Safety does your presentation address? *
Short Biography *
Topic Title *
Please list 3 things attendees will take away from your session. *
Have you conducted conducted a presentation virtually before? *
What online platforms have you used in the past? *
Required
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