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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
Morning
Afternoon
Evening
Session Duration
20 mins
30 mins
45 mins
60 mins
Presentation Type
Lecture
Panel Discussion
Workshop
Q&A Session
5. AV & Technical Requirements
Projector Needed
Yes
No
Laptop Required
Yes
No
Microphone Type
Handheld
Lapel
No Preference
Other Requirements
6. Additional Details
Do you need any travel arrangements?
Yes
No
Do you need accommodation?
Yes
No
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.
You must check the declaration box to submit.
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