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Fall 2025 Speaker Registration Form
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* Indicates required question
First Name
*
Your answer
Last Name
*
Your answer
Street Address
*
Your answer
City
*
Your answer
State
*
Your answer
Zip
*
Your answer
Phone #
*
Your answer
Email
*
Your answer
Credentials
*
Your answer
Presentation Name
(Email slide deck to carolinasleepsociety@gmail.com)
*
Your answer
What nights will you need a hotel?
*
Wednesday, October 4th
Thursday, October 5th
Required
One night hotel stay will be paid on master account, please let us know if you plan to stay longer and we can deduct the additional nights from your speaker fees
Your answer
Please list any additional travel costs that you will need to reimbursed for. Please email all receipts for reimbursement to carolinasleepsociety@gmail.com
Your answer
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