HSJ Provider Summit 2017 - Speaker Checklist

19 - 20 April 2017 | Heythrop Park, Oxfordshire
SPEAKER CHECKLIST
CONTACT & SPECIAL REQUIREMENTS
Please supply the requested information below so that we can contact you in the lead up to the event and also in case of an emergency on the day.
Title
First Name*
Last Name*
Job Title*
Organisation*
Email*
Office Number*
Mobile Number*
PA Name
PA Number
PA Email
In order to help us coordinate your pre-conference briefing call, please indicate times that are best to reach you:
09:00 - 11:00 11:00 - 13:00 13:00 - 15:00 15:00 - 17:00
Monday 5th September 1 2 3 4
Tuesday 6th September 5 6 7 8
Wednesday 7th September 9 10 11 12
Thursday 8th September 13 14 15 16
Friday 9th September 17 18 19 20
If you are not available for any of the above times, please provide a range of times below to best contact you:
We kindly ask that you let us know when you will be arriving to the Summit and your expected time of arrival.
I will be arriving to the Summit on:*
Tuesday 18 AprilWednesday 19 AprilFriday 20 April
Approximately what time do you expect to arrive?*
To ensure all arrangements are in place for you, please indicate below which elements of the event you will be joining us for.
Wednesday 19 April*
I will attend lunchI will attend the networking reception & dinnerI require accomodation, please reserve me a roomI will not be attending Day One
Thursday 20 April*
I will attend conference sessionsI will attend the closing lunchI will not be attending Day Two
Do you have any special dietary or other requirements that we should be aware of? If yes, please specify below.

	09:00 - 11:00	11:00 - 13:00	13:00 - 15:00	15:00 - 17:00
Monday 5th September	1	2	3	4
Tuesday 6th September	5	6	7	8
Wednesday 7th September	9	10	11	12
Thursday 8th September	13	14	15	16
Friday 9th September	17	18	19	20

SPEAKER PROFILE
Please supply a short biography (up to 150 words) and a high resolution JPEG photo to feature on the event guide by Friday 10 March.
These can be entered below or emailed to amie.lee@emap.com.
Do note that if we don't receive these by the above deadline, we will source a profile and photo from online sources.
Biography
JPEG photo (high resolution)
File size limit: 2MB

PRESENTATION & AV REQUIREMENTS
It is important that you inform us prior to the event of any presenting and audio visual needs. A laptop (with Microsoft PowerPoint 2010), projector, screen and a microphone will be provided as standard.
Will you be supplying a PowerPoint presentation for use on the day? Please note the deadline to submit slides is Wednesday 12 April.*
YesNo
If you are using a PowerPoint presentation, do you require any of the following:*
Video & SoundInternet ConnectionNot applicableOther
Following the Summit, presentations and event materials will be made available online for attendees. Please confirm below if you grant permission for your slides to be shared and published.*
YesNoNot applicable

Disclaimer
EMAP, part of Ascential PLC, takes your privacy seriously. By entering your details you agree to allow Health Service Journal, EMAP Ltd and companies associated with this event to contact you regarding their services.
Please indicate below how you would like to be contacted or indicate if you do not wish to receive mailings:
EmailPhoneSMSI do not wish to receive mailings
Privacy
By submitting your details you consent to them being used in accordance with your preferences above and our Privacy Policy and Terms & Conditions
I agree to the privacy policy and terms and conditions
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19 - 20 April 2017 | Heythrop Park, Oxfordshire

SPEAKER CHECKLIST