N*62 Speaker Form

Thank you for agreeing to be a speaker at the N62 Conference, scheduled for October 25 in Yellowknife, NT. Please fill out the form below.

As we approach the event, we will provide presentation guidelines, conflict of interest (COI) disclosure requirements, scheduling details, and registration information. Your presentation should include interactive activities, group discussions, and question periods.

For any questions, contact the DLRI team at dlri@ucalgary.ca.

1
Current: Personal Information
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Session Information

Full Name

Phone Number

Email Address

Please check all that apply:

FRCPC

FRCSC

CCFP

Other

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University Appointment

Clinic or Hospital

Other Affiliations

Short Biography

Head Shot

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N*62 Speaker Form

N* 62 Speaker Form