Speaker Proposal Form | Precision Med Tri-Conference

* Please Select a Track

* Proposal Title:

* 2-3 Sentence Summary (approx. 70 words):

* Why your proposal should be considered:

* What the audience will gain from your presentation:

* Short Biography: (Bio may be used in print material if proposal is accepted)

* Select : Mr. Ms. Mrs. Dr. Prof.

* First Name:

* Last Name:

Degree / Credential: (eg. Ph.D. or FACR etc.)

* Job Title:

* Department:

* Company/Organization:

* Mailing Address:

* City:

* State or Province (Canada):

* Zip / Postal Code:

* Country:

* Phone:

Ext:

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