Southwest Colorado Pediatric Mental Health Symposium - Durango, CO - Internal Planning Committee Reply Form | Children's Hospital Colorado Continuing Education

1 Speaker Form 2 Travel Plans 3 Lodging Plans 4 Financial Disclosure 5 List of Disclosures 6 Sign Off

Planning Committee Form

Thank you for participating on the planning committee for the Southwest Colorado Pediatric Mental Health Symposium - Durango, CO on September 8 and 9, 2025. Please complete the following form.

Name (first and last) *

Please provide your credentials and professional titles below for the brochure:

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

List your credentials and professional titles here: *

Email address *

Cell phone *

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Southwest Colorado Pediatric Mental Health Symposium - Durango, CO - Internal Planning Committee Reply Form

Planning Committee Form

Please provide your credentials and professional titles below for the brochure: