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.


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 


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 *
Prefix: *