If you wish to make a presentation proposal for the next Quality Colloquium please complete and submit the following:
Contact information of person proposing the presentation:
Name:
Title:
Organization:
Address:
City:
State:
Zip Code:
 Country:
Phone:
Fax:
Email Address:
Presentation Information
Presentation Title:
Description of Topic:
Target Audience (Please Describe):
Describe why your topic subject area is important.
Proposed Faculty
Please input a brief description of each proposed faculty member (i.e. Full Name, Title, Organization, etc.)
 
1.
Name:
  Title:
  Organization:
  Address:
  City:
  State:
  Zip Code: Country:
  Phone:
  Fax:
  Email Address:
  Resume:
 
2.
Name:
  Title:
  Organization:
  Address:
  City:
  State: *
  Zip Code: * Country:
  Phone:
  Fax:
  Email Address:
  Resume:
 
3.
Name:
  Title:
  Organization:
  Address:
  City:
  State: *
  Zip Code: * Country:
  Phone:
  Fax:
  Email Address:
  Resume:
     
4.
Name:
  Title:
  Organization:
  Address:
  City:
  State:
  Zip Code: * Country:
  Phone:
  Fax:
  Email Address:
  Resume:
If selected as a speaker, the information you provide will be used in the program brochure and offered for download on the web site. Please be sure the spelling is correct and all relevant titles, information about degrees, and credentials are included.