Logistics

Keynote Logistics

Thank you for agreeing to speak at the 10th Empowering Communities for a Healthy Mississippi Conference. Please complete this form to allow us to prepare for any reimbursement or payments to you. If you have any questions, please contact Dr. Ro directly at 228-313-5119. Thanks!

Name *

First

Last

Email *

Phone *

Can your presentation be shared?

Yes
No

If yes, we will add it to the WHOVA upload for following your presentation via the app or can be downloaded.

Please upload your W9 *

Click or drag a file to this area to upload.

Signature *

You agree to deliver an outstanding presentation to our attendees, be prepared, arrive on time, agree to any interviews with our media, and report any issues in advanced directly to the conference planner.

Facebook-f Instagram Twitter Pinterest Tiktok Youtube