Additional Speaker Form

This form is ONLY for additional presenters beyond the lead presenter that submitted the abstract.
If co-presenters were named during the abstract submission process and no changes are needed then this form does not need to be completed.

Guidelines

ALL presenters and co-presenters must register for Teaching Prevention and pay all applicable registration fees.

ALL additional presenters who have not been previously mentioned during the abstract submission process MUST fill out this form to ensure inclusion and correct identification in all program materials.

If you have any questions please contact mnavarro@aptrweb.org

Presentation

Presentation Title *

Primary Presenter Last Name *

Please do not fill out this form if you are the primary presenter. This form is only for additional presenters.

Presenter Information

Co-presenter Changes *

Add Presenter

Remove Presenter

Prefix: *

First Name *

Middle Initial

Last Name *

Degree(s) - do not use periods *

Full Name (as it should appear in the program) *

Email Address *

Confirm Email *

Email

Institution/Organization *

Professional Title *

Phone Number - Accepts extensions as x1234. *

Social media handle 🛈