Speaker FormThank you for serving as a speaker at the Southwest Colorado Youth Mental Health Symposium: A Community Approach - Durango, CO on September 30, 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 * Speaker Listing for activity items. Please include: 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 ClinicChildren’s Hospital Colorado Provide your speaker listing below * Speaker bio - create a brief bio introduction * Who is your employer? * Children's Hospital Colorado Team Member CU School of Medicine Provider Leave this field blank
