Conference Registration Speaker

Speaker Registration Form

This form should only be used if are presenting at the 2022 IHFDA Annual Conference

Registration Type

Podium Speaker

Poster Presenter

How many registrations

Attendee Type

In-person

Virtual

In-person Attendee - 2022 Annual Conference

Virtual Attendee - 2022 Annual Conference

Purchase Fundamental Drug Diversion Certificate

Yes

Fundamental Drug Diversion Certificate - Conference Add-on

First Name

Last Name

Title

Provide Name / Creditals to be written on agenda and conference documents.

Organization

Speaker Image Upload

Choose File

Bio File Upload

Choose File

2 - First Name

Last Name

2 - Title

2 - Provide Name / Creditals to be written on agenda and conference documents.

2 - Organization

2 - Email

2 - Speaker Image Upload

Choose File

2 - Bio File Upload

Choose File

3 - First Name

Last Name

3 - Title

3 - Provide Name / Creditals to be written on agenda and conference documents.

3 - Organization

3 - Email

3 - Speaker Image Upload

Choose File

3 - Bio File Upload

Choose File

4 - First Name

Last Name

4 - Title

4 - Provide Name / Creditals to be written on agenda and conference documents.

4 - Organization

4 - Email

4 - Speaker Image Upload

Choose File

4 - Bio File Upload

Choose File

5 - First Name

Last Name

5 - Title

5 - Provide Name / Creditals to be written on agenda and conference documents.

5 - Organization

5 - Email

5 - Bio File Upload

Choose File

5 - Speaker Image Upload

Choose File

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Payment Method

Pay with Card (Stripe)

Pay by Check/PO

Annual Conference

How To Join

Conference Registration Speaker

Speaker Registration Form