1 Speaker Form 2 Financial Disclosure 3 List of Disclosures 4 Sign Off Speaker FormThank you for agreeing to speak at the End-of-Life Nursing Education Consortium Pediatric Palliative Care October 21-22, 2024. Please complete the following form. Name (first and last) * Email address * Cell phone * Title of Presentation(s) * SPEAKER LISTING FOR BROCHURE (NAME, CREDENTIALS, ACADEMIC TITLE, EMPLOYER, CLINICAL TITLE, EMPLOYER) ExamplesKay Kinzie, MSN, RN, FNP-BCClinical ManagerImmunodeficiency ProgramChildren’s Hospital ColoradoAdam Rosenberg, MDProfessor of PediatricsUniversity of Colorado School of MedicineAttending NeonatologistNeonatal ICU and Special Care Provide your speaker listing below * Speaker Bio - Create a brief bio introduction * Are polling questions in your presentation? * No Yes Leave this field blank
