Department of Continuing Medical Education

Live Symposia
SPEAKER CONFIRMATION FORM

 

 

Please complete the following form as soon as possible so that we may adequately prepare for your presentation. If you login to your iLearn account before completing, you will be able to save your progress and return to submit the form at a later time.


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Speaker Details
Your CV will be used for administrative purposes only and will not be shared with the audience.
Files must be less than 2 MB.
Allowed file types: pdf doc docx odt.

Please provide a phone number where we can reach you on the day of the conference. This number will be used for emergencies only in the event you fail to arrive at the scheduled time. You can also provide alternate emails for us to send you speaker documentations, reminders, and/or other communications.

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Presentation Details
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Select the date your presentation is scheduled for

If you are presenting more than once, please send any additional titles and objectives via email to cme@nicklaushealth.org. You will need to provide at least 3 objectives per talk.

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Learning Objectives

Please provide at least 3 learning objectives for your presentation.

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Select this option to add a fourth or more objectives. Make sure to number any additional objectives.
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