sample project proposal

2010 Annual HIMSS Conference
Sample Proposal Form
This form is to provide you with an example of a completed submission form. In order to not unduly influence the proposals submitted, the information in this sample proposal will be used only to describe the type/ format of information we ask you to submit.
Submitter
*Required fields for submitter contact information
*Submitter First Name: Adam
Submitter Middle Initial: I
*Submitter Last Name: Bazer
Organization: HIMSS
Email: [e-mail]
Day time Phone: [phone]
Primary Speaker
Speaker Information - list the speaker's name, credentials, title, and organization exactly as you wish it to appear in the program.
*Required fields for speaker contact information
*Primary Speaker First Name: Adam
Primary Speaker Middle Initial: I
*Primary Speaker Last Name: Bazer
Credentials: (i.e.: PhD, RN, etc.)
*Title: Manager, North America
*Organization: HIMSS
*Address 1: 230 E. Ohio Ave
Address 2: Ste. 500
*City: Chicago
*State: IL
*Zip: 60601
Country: USA
*Email: [e-mail]
Upon acceptance, I would like the presentation attendees to contact me via email for inquiries regarding my session.
*Daytime Phone: [phone]
Cell Phone: 312-***-****
HIMSS Member: x Yes No
Did you attend HIMSS 2008 in Orlando? Yes - I attended HIMSS08 in Orlando
How many previous HIMSS Annual Conference and Exhibitions have you attended?:
Professional Title: Management
Worksite: Non-Profit Organization
Principal Work Focus: Education
Length of Time in the Field (years): 4
Speaker QualificationsSpeaker Biography of your professional background. (100 word maximum)
Here is where one should include a 75-100 word bio sketch that can be used for marketing purposes.
Public Speaking Experience: Required if submitting for lecture or roundtable. Not required for E-Session submitters. List the most recent three presentations you have made at regional and national meetings. Identify speaking organization,