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
First Name *
Your answer
Last Name *
Your answer
Designations (MD, DO, PhD, MPA, etc.) *
Your answer
Email Address *
Your answer
Primary Phone Number *
Your answer
City, State *
Your answer
Educational Background - Med School / Residency *
Your answer
Current Position & Employer Name *
Your answer
Please provide a brief biographical sketch about you. *
Your answer
What is your main area of focus / interest /research? *
Your answer
Please provide some of our recent lecture titles. *
Your answer
Please provide a few details of your previous speaking experiences. (Who /What / Where / When) *
Your answer
Please provide references for your past speaking engagements if available.
Your answer
Are you a member of the NCAFP or the AAFP? If not, how did you hear about us?
Your answer
Is there anything we did not ask about that you would like to add before you submit this form?
Your answer
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: Katkinson@ncafp.com or direct dial at 919-214-9058
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