HIMSS Recording Form

Full Company Name *

Company Website *

Are you planning to host the interview? *

If No, a Host will be provided for the interview.

Interviewee Name

First

Last

This information is used for emails and logistics.

Interviewee BIO

If you have a document, please email it to Myer Media.

Interviewee Headshot (only jpg, jpeg, png files allowed)

Drag & Drop Files, Choose Files to Upload

Headshot will be utilized for Video Thumbnail

LinkedIN Profile *

Should we include anyone else in email communications or recording invite? *

Headshot submit to

If you haven't scheduled your recording time:

Are you interested in additional recording opportunities? *

Would you like to learn more or have us contact you after HIMSS? *