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Speaker Name(Required)

First Last

Credentials(Required)

Email(Required)

Phone(Required)

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Existing Speaker

Address(Required)

Street Address City State ZIP Code

Employer(Required)

Job Title(Required)

For which PSRT event are you interested in speaking?

The PSRT will pay for a hotel room for one night, which night will you need hotel accommodations?(Required)

Thursday

Friday

Saturday

None, I will not need hotel accommodations

PSRT will provide a $100 honorarium to speakers(Required)

I will accept the $100 honorarium

I would like to donate my honorarium to the student scholarship

If you are a technologist, will you be attending the remaining conference for CE credits?

Yes

Maybe

Do you have any special accommodations (Wheelchair, food allergy, etc.)

Presentation Title

Are you the primary speaker or the sole speaker for this presentation?

Yes

Do you prefer presenting in the morning or afternoon? (we will do our best to accommodate requests)

Morning

Afternoon

No preference

Will have have a PowerPoint presentation?

Yes

May we share your PowerPoint presentation as a PDF on our website as a resource for members?(Required)

Yes

Do you need handouts printed for the audience?

Yes

Presentation Outline - The more detailed the outline is, the greater the chances of getting ARRT CQR approval.(Required)

Presentation objectives: after the presentation, attendees should be able to.... (please provide 3-6 objectives)(Required)

Speaker Bio(Required)

Please upload a headshot for the conference program.(Required)

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Comments

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Home / Events

Upcoming Events

PSRT Fall Virtual CE Conference

Register as an Event Speaker

Home / Events

Events

Upcoming Events

PSRT Fall Virtual CE Conference

Register as an Event Speaker

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