Experts Bureau

ATSU invites you to become a member of our Experts Bureau. Please complete the information below in detail, and attach additional information as needed. The information you provide will create your University Experts Bureau profile.

* Required Fields

Name:
Prefix *
First Name *
Middle Name or Initial *
Last Name *
Suffix (e.g. DO, MD, etc.)
 
Professional Membership number (e.g. AOA, etc)   *
Address:
Mailing Address *
City *
State *
Zip *
Phone Number *
Cell Phone Number
Email Address *
Preferred Method of Contact *
ATSU Affiliation
(Check all that apply)









Current Board Certifications (Please list)
Additional Information:

Areas of expertise/lecture topics (Please list) *
    

I am interested in speaking at an ATSU Continuing Medical Education or Continuing Education program.
 *

If yes, please indicate any specific ATSU program(s) for which you would like to be considerd a presenter.
    

I would like to assist ATSU by participating in their Experts Bureau and assist with speaking engagements and public relations opportunities.
 *

I want to participate as an ATSU media expert (provide print/on-camera media interviews as arranged by ATSU Communication & Marketing).
 *

If you are bilingual/multilingual, please indicate fluently spoken languages.
 

Attach copy of your curriculum vitae or supporting credentials. (Word document or PDF)