Speakers Info

EmpowerX Conference

Name (including Credentials) *

Email *

Do you accept our invitation to speak at the EmpoweRx Conference

Do you agree to have name and image used in brochure, programs, and materials for the promotion of the 2023 EMPoweRx Conference

Title of Presentation

Learning Objectives (if changing), CV, Bio, and Photo *

Click or drag files to this area to upload. You can upload up to 5 files.

Select the statement that best describe any financial disclosures

If yes selected in the prior question, select the affiliation/ financial interest that is the most appropriate.

If yes selected in the question 2, write the corporate organization of your affiliation/ financial interest below

02/13/23:

Speakers Info Due
- Finalized Title (if changing) and learning objectives
- Disclosures
- Headshot
- Bio

03/16/2023

04/17/23:

05/15/23:

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