Physician Speaker Registration

Join us as a speaker and share your expertise with the oncology community

1. Personal Information

Full Name *

Designation / Title

Specialty

Medical Registration Number

Hospital / Clinic / Organization

Years of Experience

2. Contact Information

Email Address *

Mobile Number *

Office Number (Optional)

Address

3. Proposed Topic for Presentation

Selected Topic *

Brief Description of Presentation (2 or 3 lines)

4. Session Preferences

Preferred Date

Preferred Time Slot

MorningAfternoonEvening

Session Duration

20 mins30 mins45 mins60 mins

Presentation Type

Lecture
Panel Discussion
Workshop
Q&A Session

5. AV & Technical Requirements

Projector Needed

YesNo

Laptop Required

YesNo

Microphone Type

HandheldLapelNo Preference

Other Requirements

6. Additional Details

Do you need any travel arrangements?

YesNo

Do you need accommodation?

YesNo

Any additional notes

7. Declaration

I hereby declare that all the information provided in this registration form is true, complete, and accurate to the best of my knowledge. I understand that any false or misleading statements may lead to the rejection of my application.