2024 BCSLS Congress Speaker Registration

Personal Information

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* 1. First name

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* 2. Last Name

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* 3. Title

Dr.

Ms.

Mrs.

Mr.

Other (please specify)

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* 4. Credentials:

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* 5. Contact Information

Address

Address 2

City/Town

Province

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* 6. Your email

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* 7. Your Cell phone number

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* 8. Work/Job/Career

Your job title

The company/organization you work for

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* 9. If you will be having a co-presenter, then what is her/his full name and title (Dr. Mrs, etc...), credentials and email.

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* 10. Are you being sponsored by your company or employer? They will be covering your expenses.

Yes

No

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