Speaker Engagement Request

If your organization is hosting a professional development or networking event and you would like our CEO and Claims Compliance Officer Ed Norwood to appear, please submit this request form, and our team will reach out to you. If your organization would like to receive training for your personnel, please visit the Training Courses section of our Online Store.

Thank you.

* = required

*Which session/event are you interested in booking:
5 Things Government Payors Don't Want You To KnowPCCPP IntroPCCP IPCCP IIPCCP URPCCP VAPCCP ERISAPCCP ACCELERATEDRent ERN Training Center VenueOther

For 'other,' please describe below:

Organization

*Organization

*Street Address 1

Street Address 2

*City

*State

*Zip

*Country

*Phone

Fax

Website

Contact Person

*Title

*Full Name

*Suffix

*Email

*Phone

*Has Ed Norwood ever spoken at one of your events?

*How did you first hear about Ed Norwood?

Event Details

*Event Information/Dates of Event:

*Times of Event:

*Dates Requested:

*Brief description of event and its purpose:

*Others Speaking (enter 'none' for no one):

*Expected Attendance:

*Will Ed be paid an honorarium for his time and investment?

*Will Ed be permitted to sell products?

*May we have one table to display and sell training products?

Additional Details/ Miscellaneous Information:

Venue Information

*Venue Name:

*Address Line 1:

*Address Line 2:

*City:

*State/Province:

*Postal Code:

*Country:

*Airport Information/Nearest Commercial Airport to your Location:

*Will hotel accommodations be provided?