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Annual Conference
2022 Conference
Past Conferences
How To Join
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Partners
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About Us
Annual Conference
2022 Annual Conference
Past Conferences
How to Join
Membership
Partners
Corporate Opportunities
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
- Select -
1
2
3
4
5
Attendee Type
In-person
Virtual
In-person Attendee - 2022 Annual Conference
1 @ $400 each
2 @ $400 each
3 @ $350 each
4 @ $350 each
5 @ $350 each
Virtual Attendee - 2022 Annual Conference
1 @ $400 each
2 @ $400 each
3 @ $350 each
4 @ $350 each
5 @ $350 each
Purchase Fundamental Drug Diversion Certificate
No
Yes
Fundamental Drug Diversion Certificate - Conference Add-on
1 @ $150 each
2 @ $150 each
3 @ $150 each
4 @ $150 each
5 @ $150 each
First Name
Last Name
Title
Provide Name / Creditals to be written on agenda and conference documents.
Organization
Email
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 - 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
No payment items has been selected yet
Payment Method
Pay with Card (Stripe)
Pay by Check/PO
Pay with Card (Stripe)
Submit Form
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