Please complete by Monday, February 15, 2021

The ECHO ISPCTN Branding Working Group is creating a revised Speakers Bureau that will be a part of the "branding toolkit" for the Network.

While the branding plan is still in draft form and not final, the DCOC is reaching out to sites to update the bureau.

If you are interested in being a part of this bureau, please complete the profile below.

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* 1. Clinical site awardee name

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* 2. List the institution name, if different from the clinical site name.

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* 3. Speaker name with credentials

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* 4. What is your rank at your institution?

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* 5. What is your role at your institution as part of the ECHO ISPCTN?

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* 6. Contact email

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* 7. Contact phone number

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* 8. Please describe your area of expertise.

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* 9. What are your top 4 interests for presentation?

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* 10. Speaker Bio

PDF, DOC, DOCX, PNG, JPG, JPEG file types only.
Choose File

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* 11. Speaker Head Shot

PDF, DOC, DOCX, PNG, JPG, JPEG file types only.
Choose File

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