Speaker FormThank you for agreeing to speak at the Pediatric Mental Health Symposium, Casper, WY, May 13-14, 2026. Please complete the following form. Name (first and last) * Email address * Cell phone * Title of presentation(s) * List one objective per presentation for the brochure and accreditation purposes * Speaker Listing for the brochure. Please include: name, credentials, academic title, employer, clinical title, and employer. Please use the format seen in the examples below:Format Example: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 Provide your speaker listing below * Speaker bio - create a brief bio introduction * Leave this field blank
