Patient Safety Speakers Coalition

Apply to Become a Speaker

Please complete this form if you would like to be considered as a speaker of the Patient Safety Speakers Coalition. After completing the form below and supplying a video the PSMF team will meet to determine if you are a good fit for our program. We will respond to all submissions within 10 days.

Name*
First Last
Email*
Please select what category you fall in:*
In order for us to adequately determine if you are a good fit to speak on the speakers coalition, please submit a recording of you answering the following questions:
1. Please briefly share with us your experience in improving patient care.
2. Please briefly share with us your experience of dealing with medical errors or unsafe care and provide an example.
3. Please tell us what inspired or influenced you to advance your work in patient safety.
4. Are you comfortable speaking to a layperson audience and can you give us an example of how you would explain a medical incident to a layperson?

Any additional information you would like to add for us to take into consideration?

Upload Video Recording (please keep under 5 minutes)*

Max. file size: 100 MB.

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Patient Safety Speakers Coalition

Apply to Become a Speaker

In order for us to adequately determine if you are a good fit to speak on the speakers coalition, please submit a recording of you answering the following questions: