Speaker Bureau

DRAFT FOR TESTING

Request an NCQA Speaker

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MM slash DD slash YYYY
MM slash DD slash YYYY
Address*
This event will be...*
Company Address*

Primary Contact

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Is this a public or private event?*
Will the event be supported by industry or commercial funding (e.g., sponsorships, grants, etc.)?*
Will the presentation be recorded?*
Will your organization reimburse the speaker’s travel expenses, such as airfare, lodging and meals?*
Will your organization share a list of the attendees (name, organization and email address) with NCQA after the presentation?*
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