PeDRA Speakers Bureau Database Form General Information First Name Last Name Credentials Email Institution Speaking Preferences Preferred Topic(s) - Please list up to three. Preferred Presentation Duration (ex: 30-60 minutes) Target Audience - who is this lecture for?DermatologyPediatric DermatologyPediatricsPatient AdvocatesIndustry RepresentativesOther Other audience(s) Career stage appropriateness for the target audience(s).Medical StudentsResidentsClinical FellowsEarly InvestigatorsMid-career InvestigatorsSenior InvestigatorsOther Other - please specify Preferred Presentation FormatIn-person onlyVirtualPre-recorded webinarPre-recorded podcastPanelOther Other - please specify Are you willing to travel to give your lecture?YesNo Sharing Agreement PeDRA may make this information available to PeDRA members only through the use of a protected member log-in on the PeDRA website. I acknowledge that my information will be shared with PeDRA members via the PeDRA member resources page behind a protected member log-in on the PeDRA website.I do not wish to share this information and wish it to remain internal to PeDRA staff only. Contact Information
