Christopher Ward Pediatric Neuroscience Conference 2024 - Speaker Reply Form - With Travel Preferences | Children's Hospital Colorado Continuing Education

Speaker Form

Thank you for agreeing to speak at the Christopher Ward Pediatric Neuroscience Conference on August 9, 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 Clinic
Children’s Hospital Colorado

Provide your speaker listing below *

Speaker bio - create a brief bio introduction *

Are polling questions in your presentation *

Yes

N/A

Do you require a honorarium?

This is not a guarantee of honorarium or the amount of payment. All requests will need approval from the planning committee.

Yes

If so, please list your requested honorarium amount

This is not a guarantee of honorarium or the amount of payment. All requests will need approval from the planning committee.

Leave this field blank

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Christopher Ward Pediatric Neuroscience Conference 2024 - Speaker Reply Form - With Travel Preferences

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