Grand Rounds Speaker Bureau Request Form

Hopkins Grand Rounds Speakers Bureau Request Form

Fill out this form to request a speaker.

REQUESTOR INFORMATION

Hospital Name «

Hospital Address

City

State

Zip Code

Contact Name

Contact Address

City

State

Zip Code

Contact Phone Number

Contact Fax Number

Contact E-mail «

Location of where lecture is held within your hospital

Do you provide an honorarium?

Yes No

If so, what is the average amount provided?

What time are Grand Rounds held at your hospital?

Speaker

HOPKINS SPEAKER BEING REQUESTED

In the fields below, please request a topic and 3 available dates for each topic. Up to five topics can be requested with 3 choices of dates for each topic.

Topic 1

Preferred Date

Alternate Date

Questions or Concerns

Topic 2

Preferred Date

Alternate Date

Questions or Concerns

Topic 3

Preferred Date

Alternate Date

Questions or Concerns

Fields marked with « are required.

Quick Links

For Employees | Legal Disclaimer | Site Map

The Johns Hopkins Hospital Recent Recognitions

--- Select from the following ---
Dr. Edward Ahn
Dr. Mohamed Atta
Dr. Theodore P. Abraham
Dr. Dana Andersen
Dr. Charles Balch
Dr. William Baumgartner
Dr. Ronald d. Berger
Dr. James Black
Dr. Roger Blumenthal
Dr. Kofi Boahene
Dr. Jeffrey A. Brinker
Dr. Patrick Byrne
Dr. Hugh Calkins
Dr. Duke Cameron
Dr. John Conte
Roni Dinkes, Au.D. CCC-A
Dr. Christopher Earley
Dr. David Feller-Kopman
Dr. John Flynn
Dr. Gary Gallia
Dr. Charlene Gamaldo
Sue Garman, M.S., CCC-A
Dr. Romergryko G. Geocadin
Dr. Frank Giardiello
Dr. Shertia Golden
Dr. Sheldon H. Gottlieb
Dr. Christine Gourin
Dr. Ernest Graham
Dr. Robert Guintoli
Dr. Ahmet Gurakar
Dr. John Harmon
Dr. Judy Huang
Dr. George Jallo
Dr. Daniel P. Judge
Dr. Jacqueline Junkins-Hopkins
Dr. Peter Kaplan
Dr. Edward K. Kasper
Dr. Richard A. Lange
Dr. Linda Lee
Dr. Zhiping Li
Dr. Michael Lim
Dr. Sandra Lin
Dr. Rafael Llinas
Dr. Meredith Loveless
Dr. Lowell Maughan
Dr. Susan A. Mayer
Dr. Abhay Moghekar
Dr. Robert Montgomery
Dr. Gerard Mullin
Dr. Richard O’Brien
Dr. Patrick I. Okolo
Dr. Alessandro Olivi
Dr. Pam Ouyang
Dr. Timothy Pawlik
Dr. Michael Polydefkis
Dr. Wendy Post
Dr. Alfredo Quinones-Hinojosa
Dr. Elizabeth Ratchford
Dr. Richard J. Redett
Dr. Douglas D. Reh
Dr. Jon R. Resar
Dr. Jeremy Richmon
Dr. Jason Rosenberg
Dr. Stuart Russell
Colleen Ryan, MS CCC-A
Dr. Ned Sacktor
Dr. Roberto Salvatori
Dr. Michael Trice
Dr. Ashish Shah
Lillie Shockney, RN
Dr. Luca Vricella
Dr. Gary Wand
Dr. Timothy Witham
Dr. David Yuh
Dr. Susan J. Zieman

Education

Information For

Grand Rounds Speaker Bureau Request Form