Return to KidneySpeak Home

Request a Speaker

In order to process your request, please provide the following information. Please allow 10 work days to process. Contact Information: Contact Person: Organization/Company: Address: City: State: Zip: Phone Number: Cell Phone Number: Fax Number: E-mail Address: Best time to reach you:     Event Information: Date of Event: Estimated Number of Attendees: Name of Meeting: If known, approximate time of speaking engagement: to Who is hosting the meeting? Equipment: Can you provide LCD projector?   Yes      No Can you provide PA as needed?   Yes      No Is there a particular topic/concern you are addressing at the meeting? Name of Meeting Location: (please supply as much information available at this time (i.e. hotel, convention center, etc.) City: State: Zip:     Please check presentation(s) you are interested in. For General Audience: Chronic Kidney Disease (CKD) Organ Donation A Patient Perspective – Inspirational For Healthcare Professionals: Promoting Patient Participation in the Dialysis Setting* Kidney Survivor: Lessons Learned from Experience* Empowering Patients to be Their Own Advocate* For People with Kidney Disease: CKD Treatment Options Your Achy Breaky Heart: What You Need to Know About     Secondary Hyperparathyroidism* Kidney Survivor: Lessons Learned from Experience* Make Yourself a Perfect 10!* Taking Charge and Adding Life to Your Years* * PEPP Presentations     Additional Comments:

 

KidneySpeak is sponsored in part by: