Endo Days Spring 2023 Speaker Intake Questionnaire
Thank you for participating in our Endo Days program. Jonathan Halldorson is the administrator for Endo Days and will be your go-to (in addition to Board President Dr. Alan Failor). Let me you if you have any questions or support needs throughout the process.

Please review the linked conference agenda here: https://drive.google.com/file/d/1OZLogIzvE32CQfF-Ee0REKVqLrU9VVYf/view?usp=share_link
Email *
How would you like your name be displayed on documents/ our website (including credentials)? *
What are your credentials (MD, FACE, etc.) *
Submit any alternate e-mail(s) you want to us to correspond with you (Enter N/A if only one). *
Submit any name(s) and email address(es) for admin assistant(s) you want us to correspond with (Enter N/A if only you). *
Honorarium: We provide a $500 honorarium per presentation for our local speakers highly regarded in your field. Away speakers (Drs. Cefalu and Auchus) receive a $2500 honorarium. Local speakers will need to submit your physical mailing address here (using the 3rd entry option) for Jonathan to mail your honorarium check. Anticipate honoraria to be sent ~45 days after the conference, with evaluation summary from attendees. Alternatively, should you desire, you may donate your honorarium back to Endocrine Days Educational Institute. *
Reviewing the agenda above, please note the time of your live presentation on Friday 31 March 2023 and confirm availability. *
Would you like to change your session title? If yes, type in the new title(s) in the other option. *
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