USRC 2022 Speaker Form

Would you like to speak at USRC 2023? Call for Speakers for Utah State Respiratory Society Conference.

Please fill out the form below to be considered as a speaker for the 2023 Virtual USRC State Conference. Deadline for submission is December 1, 2022. Decisions on speakers will be made in early January and you will receive notification by January 31, 2023.

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Select Presentation Type

Presentation

Open Forum

Topic Content Area

Request for AV or Additional Equipment

I DO NOT need any additional equipment

I NEED additional equipment

I Agree to be videoed for education purposes for this conference

Yes

Powerpoint Presentation

Please email your presentation to utahsrc@gmail.com no later than 1 week before the conference.

A PDF copy of your presentation may be included in the participants registration packet in a printed or electronic format at the discretion of the USRC.

CONFLICT OF INTEREST: An individual involved in the planning of, or presentation of, an education activity may have an interest in or affiliation with an organization, but the audience must be informed of this relationship before the presentation of the activity. For this purpose, a real or apparent conflict of interest is defined as personal gain or benefit derived from involvement with any entity, product or service. Vested Interest includes (but is not limited to) employment, by owning stock, from inclusion in a speakers' bureau or a relationship, personal or otherwise, with a company that could potentially benefit from the relationship. I recognize that I must follow all criteria regarding vested interest and declare that: MARK ONLY ONE.

I declare that I do NOT have any affiliation with or financial relationship with the educational content of this program.

I have an affiliation or financial relationship/interest which could be perceived as posing a potential conflict of interest with the educational program.

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