AOOP: Academy of Occupational and Organizational Psychiatry

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Speakers' Bureau

Registration and Agreement Form

In order to be listed as a speaker with the AOOP Speakers Director, please fill out and sign this form below; and return to AOOP. You must be a current member of AOOP to be a member of the Speaker Bureau. If you have any questions, please do not hesitate to contact us at (877) 789-2667, or via e-mail at staff@aoop.org.

Name:

Company Name:

Street Address:

City:

State:    Zip:

Phone #:
Fax #:

E-mail:

Describe briefly your prior public speaking experience, especially the ones that involve speaking to an audience:

Please indicate below your areas of professional expertise about which you would be interested in speaking:

Depression in the Workplace
Fitness for Duty Evaluations
Executive Training
Evaluations and Coaching
The Expatriate Family
Stress and Anxiety in the Workplace
Substance Abuse in the Workplace
Organizational Development

Please indicate any subjects you would to see included above:

I, the undersigned, understand and agree that I will be thoroughly familiar with both the American with Disabilities Act and the Family Leave Act and how each may affect the treatment and disposition of employees with mental health problems in the workplace. I also agree to follow the AOOP topic outlines for the topic that I am invited to address:

Signature: Date:

Please print and return this form by fax or mail to AOOP.

 

 
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Last Modified: 10/08/2007