4th Annual Children's Hospital Colorado Virtual Pediatric Symposium- Speaker Form

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

Speaker Form

Thank you for agreeing to speak at the 4th Annual Children's Hospital Colorado Virtual Pediatric Symposium. Please complete the following speaker 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 Clinic
Children’s Hospital Colorado

Provide your speaker listing below *

Speaker bio - create a brief bio introduction *

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Speaker Form

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

Examples

Kay Kinzie, MSN, RN, FNP-BCClinical ManagerImmunodeficiency ProgramChildren’s Hospital ColoradoAdam Rosenberg, MDProfessor of PediatricsUniversity of Colorado School of MedicineAttending NeonatologistNeonatal ICU and Special Care ClinicChildren’s Hospital Colorado

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 Clinic
Children’s Hospital Colorado