Request a Speaker

Complete the form below to let us know how one of our speakers can participate at your event.

Society
Name of Society*
Address of Meeting
Street Address City State ZIP Code
Contact
Contact Person*
First Name Last Name
Email Address*
Cell Phone Number*
Presentation
The College will provide transportation for the speaker. We ask the society to provide hotel accommodations and meals.
First Choice Presentation Date*
YYYY dash MM dash DD
Second Choice Presentation Date
YYYY dash MM dash DD
Your choice of subject for the talk:
- Practice Management
- Socioeconomic/Government Regulations
Need to contact us?
Practice Management
Jennifer Pfeifer
jenniferpfeifer@acaai.org
847-725-2280

Socioeconomic/Government Regulations
Susan Grupe
suegrupe@acaai.org
847-725-2305
Consent*
I agree that my submitted data is being collected and stored.*
Name
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Society