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CAMSS Annual Education Speaker Pre-Screening Form 2026
On behalf of the CAMSS Board, thank you for your interest in speaking at our educational forum.
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1.
Title of Presentation (This will be used in marketing/brochures):
(Required.)
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2.
Target Audience:
(Required.)
New MSP's
Seasoned MSP's
Payer Enrollment Professionals
CVO
Medical Staff Leaders
Administrative Leaders
Other (please specify)
*
3.
Objectives (at least 3 required; will be used to apply for CEU's):
(Required.)
1.
2.
3.
4.
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4.
Session Description (75 words or less) (This will be used in marketing/brochures to describe your program & to apply for CEU’s):
(Required.)
*
5.
Primary Speaker Information
(Required.)
First Name, Last Name, Degree:
Company/Institution Name:
E-mail Address:
Mobile Phone #:
Preferred Mailing Address Line 1:
Preferred Mailing Address City, State, Zip Code:
Administrative Assistance Name (If applicable):
Administrative Assistance E-mail (if applicable):
Administrative Assistance Phone (if applicable):
*
6.
Additional Speakers?
(Required.)
Yes
No