2024 Speaker Information & Disclosures_invited

The speaker confirmation process is 2 steps. (Step 1) Complete this form with the personal and program information and the financial disclosures. (Step 2) The AADGP Program committee will review your submission and upon acceptance will send your speaker agreement with specific dates and times of your session.

The form will take approximately 15 minutes to complete. You may save your work and complete it at a later time.

Contact Information

To ensure you are correctly listed in our program materials, please complete the following information:

Presenter Name(Required)

First Last

Credentials

As you would like to see them in the program.

Title

Company or Institution(Required)

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email(Required)

Work Phone(Required)

LinkedIn profile

May we tag you on LinkedIn?

Yes

No

Mobile Phone(Required)

Internal Use Only

Emergency Contact Information

In the unlikely event of an emergency please contact

Emergency Contact Name

First Last

Emergency Contact Relationship

Emergency Contact Phone

Emergency Contact Mobile Phone

Personal Biography

Tell us about yourself! Upload a CV or give us a brief summary about your unique skill set and experience.

Biography(Required)

Please provide a short Biography to be published in our conference program.

Biography Upload Option

As an alternative to the section above you can upload your biography if you prefer.

Drop files here or

Accepted file types: doc, pdf, Max. file size: 128 MB.

Biography (Introduction)

Please provide a short biography you would like to be part of your spoken introduction at the event, if different from the above bio for publishing.

(Optional) Additional info

If you wish, please provide some fun facts, outside of your professional bio, that attendees may want to know about you. i.e. Likes to travel, can ride a unicycle, etc.

Headshot(Required)

Please upload a current headshot for promotional purposes for the Expo.

Accepted file types: jpg, png, pdf, Max. file size: 128 MB.

Program Material

Session Title

Session Description(Required)

If you are participating in a Panel you will be contacted separately regarding content to be covered. Simply write PANEL in the box.

Learning Outcomes(Required)

A learning outcome describes in observable and measurable terms what a student is able to do as a result of completing a learning experience. Panelists may write PANEL.

Are you willing to record a short (60 seconds or less) testimonial video to promote your session?

We will contact you accordingly.

Absolutely!

Yes, but ask me later.

Not sure, tell me more.

No thank you.

Digital Signature(Required)

Having read and understood the Academy's policy and having completed this statement to the best of my knowledge and belief, I agree to be bound by the terms hereof.

Date(Required)

2024 AADGP Speaker Form

Thank you in advance for the commitment to our Annual Meeting.

Your contribution will ensure we have a great meeting.

Please complete the following form.

2024 AADGP Annual Meeting Speaker Information & Disclosure Form

Contact Information

Emergency Contact Information

Personal Biography

Program Material

Conflict of Interest Statement