Endo Days Spring 2022 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.
Email *
How would you like your name be displayed on documents/ our website (including credentials)? *
Submit any alternate e-mail(s) you want to us to correspond with (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 $2500 honorarium for "away" speakers highly regarded in your field (Dr. Tannock) and a $500 honorarium per presentation for our local speakers highly regarded in your field. Anyone whose honorarium exceeds $600 per calendar year (i.e., Drs. Tannock, Tuttle) will need to complete a W-9 (electronically via QuickBooks, see separate email). Others 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 30 days after the conference, with evaluation summary from attendees. Alternatively, should you desire, you may donate your honorarium back to Endocrine Days Educational Institute. *
Please review our draft agenda here <https://drive.google.com/file/d/12M2JgKt06XRR3RH1v31fGMiKaq6osuEg/view?usp=sharing>. If you want to change the title of your presentation, please submit your title change request here: *
Reviewing the agenda above, please note the time of your live presentation on Friday 5/6/22 and confirm availability. *
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms