Speaker Agreement & Registration Form

Before completing the form, please be prepared to include the following information:

2-3 sentence speaker bio and headshot photo for the event website, introductory purposes, and promotional material.
2-3 learning objectives - key information about expectations for learning objectives can be found here. Please avoid verbs that are often used but are open to many interpretations. Some suggested verbs include: decide, describe, explain, compare. For further information, click here.
Social media accounts for promotional content.
A completed conflict-of-interest (COI) declaration form for accreditation.
Read the diversity and speaker policy.
Read the speaker release for video and audio recording.

Speaker Information

Title

Name

First Name

Last Name

Post-nominal initials

Pronouns

Phone

(###)

###

####

Institution

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Speaker biography (2-3 sentences)

Instagram

http://

Learning Objectives

Presentation Title

Learning objective #1

Learning objective #2

Learning objective #3

Disclosures

Diversity and speaker policy

I acknowledge that I have reviewed the diversity and speaker policy.

Speaker release for video and audio recording

Yes, I consent.

No, I do not consent.

Land Acknowledgement

This Congress is being held in Vancouver, British Columbia. In the spirit of Truth, Reconciliation, Friendship, and Reciprocity, we would like to acknowledge that we are on the traditional, ancestral and unceded territory of the Coast Salish peoples, including the territories of the xʷməθkwəy̓əm (Musqueam), Skwxwú7mesh (Squamish), Stó:lō and Səl̓ílwətaʔ/Selilwitulh (Tsleil-Waututh) Nations. This place is a testament to the enduring presence and resilience of Indigenous Peoples, and we honour their deep connection to these lands and waters.