NCAFP Interested Speakers' Survey
We appreciate your interest in possibly speaking/presenting during an NC Academy of Family Physicians event. To assist us in learning more about you, your industry experience and your areas of interest, please complete the brief survey below. Thank you for your time.  - Sincerely, Kathryn Atkinson, CMP | Manager of NCAFP Meetings & Events

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First Name *
Last Name *
Designations (MD, DO, PhD, MPA, etc.) *
Email Address *
Primary Phone Number *
City, State *
Educational Background - Med School / Residency *
Current Position & Employer Name *
Please provide a brief biographical sketch about you. *
What is your main area of focus / interest /research? *
Please provide some of our recent lecture titles. *
Please provide a few details of your previous speaking experiences. (Who /What / Where / When) *
Please provide references for your past speaking engagements if available.
Are you a member of the NCAFP or the AAFP? If not, how did you hear about us?
Is there anything we did not ask about that you would like to add before you submit this form?
Thank you for your time today and for providing the information above. If an opportunity to present a session on your topics of expertise and interest becomes available, we will be in touch with you. Thank you again for your interest and support of the NCAFP. Sincerely, Kathryn Atkinson, CMP | Manager of NCAFP Meetings & Events
 Contact Info: or direct dial at 919-214-9058
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