38th Annual Community and School Health Pediatric Conference - Speaker Reply Form | Children's Hospital Colorado Continuing Education

1 Speaker Form 2 Financial Disclosure 3 List of Disclosures 4 Sign Off

Speaker Form

Thank you for agreeing to speak at the 38th Annual Community and School Health Pediatric Conference on June 13-14, 2024. Please complete the following form.

Name (first and last) *

Email address *

Cell phone *

Title of Presentation(s) *

List one objective per presentation for brochure *

SPEAKER LISTING FOR BROCHURE (NAME, CREDENTIALS, ACADEMIC TITLE, EMPLOYER, CLINICAL TITLE, EMPLOYER)

Examples

Kay Kinzie, MSN, RN, FNP-BC
Clinical Manager
Immunodeficiency Program
Children’s Hospital Colorado

Adam Rosenberg, MD
Professor of Pediatrics
University of Colorado School of Medicine
Attending Neonatologist
Neonatal ICU and Special Care

Provide your speaker listing below *

Speaker Bio - Create a brief bio introduction *

Are polling questions in your presentation? *

Yes

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38th Annual Community and School Health Pediatric Conference - Speaker Reply Form

Speaker Form

SPEAKER LISTING FOR BROCHURE (NAME, CREDENTIALS, ACADEMIC TITLE, EMPLOYER, CLINICAL TITLE, EMPLOYER)