PEPP Speaker Request Form

Download Speaker Request Form in MSWord

Or copy and paste the following into the body of an email and send to  Lori@RSNhope.org

Contact Person
Organization/Company
Address
City State Zip
Phone
Cell Phone
Fax
E-Mail


Date of Event:
Approximate time of speaking engagement (if known):
Estimated Attendance:
Name of Meeting:
What organization is hosting the meeting?
Meeting Location (please supply as much information available at this time as you know, i.e., hotel, convention center, etc.):
City
State
Zip

Please check presentations you are interested in learning about. For more information about the presentations, click here.

For Patients
__Your Achy Breaky Heart: What You Need to Know About Secondary Hyperparathyroidism
__Kidney Survivor: Lessons Learned from Experience
__Taking Charge and Adding Life to Your Years
__Make Yourself a Perfect 10!

For Professionals
__Promoting Patient Participation in the Dialysis Setting
__Empowering Patients to be Their Own Advocate
__Kidney Survivor: Lessons Learned from Experience

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