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Speaker Proposal
* Proposal Title:
* 2-3 Sentence Summary (approx. 70 words):
* Why your proposal should be considered:
* What the audience will gain from your presentation:
* Short Biography: (Bio may be used in print material if proposal is accepted)
* Select :
Mr.
Ms.
Mrs.
Dr.
Prof.
* First Name:
* Last Name:
Degree / Credential: (eg. Ph.D. or FACR etc.)
* Job Title:
* Department:
* Company/Organization:
* Mailing Address:
* City:
* State or Province (Canada):
* Zip / Postal Code:
* Country:
* Phone:
Ext:
*I would like to receive future notices and communications from CHI relevant to my interests through the following channels:
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None
*We may occasionally send you, via email, industry relevant product & service information on behalf of our marketing partners.
Yes, I want to receive this information.
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#neurotech21