CPSI 2017: Proposal Process

 

GENERAL INFORMATION

 

Primary Email:
*

 

An email confirmation will be sent to the email address provided above.

 

Salutation:
Presenter's First Name:
*
Presenter's Last Name:
*
Presenter's Job Title:
Presenter's Organization/Employer:
Presenter's Address:
*
Address 2:
City:
*
State:/Providence:
*

If Other (Non US/Canada), please type 00000 in Postal Code.

Zip (Postal Code):
*
Country:
*

   

Presenter's Mobile Phone:
*
Presenter's Other Phone:
Presenter's Website:
Presenter’s Twitter Username (i.e. @CPSIconference):
LinkedIn Profile URL:
Facebook Profile URL:
CPSI may list my name, company, country, website and/or social media on the CPSI website and/or in the CPSI Program Book:
*
How did you hear about us?
*
If by Friend or Colleague, please indicate specific names, etc. If NOT, please enter N/A.
*
If Other, please indicate specific names, etc. If NOT, please enter N/A.
*

 

 

CREATE PASSWORD

 

Please create a password to allow you to access your proposal again. Your password should have a minimum of 8 characters and at least one number. Special characters should not be used.

 

Password:
*
Confirm Password:
*

 

Next: Demographics