Las Vegas 2020 Speaker Submission Form

Date*

Name*

First Last

Email*

Best Contact Phone*

Company Information (if applicable)

Website

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Are you a Bariatric Patient?*

Yes
No

Occupation*

Areas of Expertise*

Qualifications/Credentials Relative to Speaker Experience*

Company Affiliations (if applicable)

List 3 Most Recent Conference/Meetings in Which You Participated as a Speaker, and Include Any Published Links from the Presentation.

Proposed Session Topic*

Description for Proposed Topic*

Please List Takeaways for Proposed Session Topic*

Are You Willing to Attend the Conference as a Speaker and Cover Your Travel and Hotel Expenses?*

Yes
No

Consent*

Yes, I confirm

By checking this box, you understand that speaking opportunities for the WLSFA Convention are limited and that submitting your interest and topic does not mean that we are able to accommodate it on the Program Agenda. In addition, you also understand that topics submitted are recommendations, and that it is possible that the Program Agenda Committee may select your topic, but may no be able to assign you as a presenter due to budget constraints. All topics and potential presentation ideas submitted but be fresh content and should not be a presentation previously given at another conference/meeting.

Phone

This field is for validation purposes and should be left unchanged.