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Home
About
Agenda
Speakers
Registrations
General Registrations
MSDH Employees Registrations
Student Registration
Pre-Conference
Pre-Conference Sessions
Healthy Workplace
Exhibitiors
Partner Sponsorship
Exhibitors & Sponsors
Hotel
ECHMC
ECHMC Sponsorship Package
ECHMC Press Release
Evaluation
10 Empowering Conference Evaluation
10 Empowering Session Evaluation
Register
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!
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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
*
Clear 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.
Submit
