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Patient Authentic Speaker Database Application

Thank you for your interest in being added to our speaker database! This means you will be considered for our upcoming event, as well as any future events that align with your industry / speaking topics. Our typical audience is patient advocacy group leaders and individual patient advocates/influencers. We welcome potential speakers who specialize in healthcare and advocacy as well as leaders outside of healthcare with expertise in topic areas of interest Please fill out this form to apply.

Bio


Headshot
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Specialties / Speaking topics
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Can we share your email with fellow attendees and speakers for follow up collaborations after the event?
Are there any accomodations you will need when traveling for Patient Authentic events?
Dietary restrictions, allergies, fridge in room, accessible hotel room etc.


Anything else you would like to share?


By submitting this form, I hereby acknowledge that I assume any and all risks of loss, damage or injury that may occur by or as a result of participation in Patient Authentic Events, without limitation or qualification, and I waive all claims against Patient Authentic arising from or related to such assumed risks.
By submitting this form, I hereby grant permission Patient Authentic to use my name and likeness in photographs, videos, or other digital media created during any Patient Authentic event n which I participate, in Patient Authentic's publications (digital, web-based or otherwise) and on its social media channels and accounts.

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