Account Profile

Please complete the information below and then press the 'Create Account' button.
You will be the contact person for all information that you submit in this speaking proposal.

As the submitter for this proposal, you are the keeper of all data. Once all tasks are complete, you are responsible for submitting for the group.

* indicates a required field

Personal Details

Prefix

First Name

Middle Initial

Last Name

Suffix

Pronouns
  he/him/his
  she/her/hers
  they/them/theirs
  Self-describe:

Mailing Address

Address Line 1

Address Line 2

Address Line 3

City

State

Zip

Country

Contact Details

Office Phone

Cell Phone

Fax

Administrative Assistant or Main Contact for Speaker(s) (they will be copied on all submission emails)

Name

Telephone

Not Applicable

Professional Information

Professional Title

Company / Organization / Institution

Credentials

Not Applicable

Membership

Are you a MGMA member? *You are not required to be a MGMA member to speak

Membership Number

Not Applicable

Password

Please create a password for your submission.
The password must be at least 8 characters long and contain a character from three of the following character sets: uppercase letter, lowercase letter, number, or non-alphanumeric character.

Create Password

Re-type Password