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In order to become a member of the Speakers Bureau, please fill out the following form and click the submit button below. Once received, you may be contacted for speaking engagements. Only members of AAAAI may join the Speakers Bureau.


1) Name:

2) Address:

      City: State: Zip:

3) Phone: Fax:

4) E-Mail:

5) How far are you willing to travel for a speaking engagement?
    

6) I am a:
AAAAI Allied Health member in good standing 
AAAAI Member in good standing
AAAAI Fellow in good standing
AAAAI Fellow-In-Training

7) Key Topics of Interest/Expertise:
    

8) List three recent speaking engagements (topic, audience,type of event):

    a)

    b)

    c)

Questions? Please call AAAAI Membership Services at (414) 272-6071 or E-mail info@aaaai.org

  

 



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