17th Annual Scientific Meeting Speaker Confirmation « ISCTM | The International Society for CNS Clinical Trials and Methodology

Email Address*

Last Name*

First Name*

Degree(s) or Designation(s)*

Phone

Assistant's Name

Assistant's Email

Video/Presentation Release Acknowledgement*

I understand that my presentation will be recorded and broadcast to registered attendees during the virtual meeting and will be available to attendees for 30 days.

Release Authorization Request: To disseminate information of value to the field, ISCTM posts slide presentations and session presentation videos on the ISCTM website. Your cooperation in providing consent to post these slide presentations and videos on the website will be greatly appreciated. Note: all panel/audience discussion segments are posted.

Presentation Release Authorization*

Yes, ISCTM may include my presentation on its website.
No, ISCTM may not include my presentation on its website.

Video Release Authorization*

I release the video recordings of my presentation for posting only to the ISCTM website.
I do not release video recordings of my presentation.

Disclosures: Please list all applicable, including grants, honoraria, shares, paid positions, advisory boards, other*

Disclosure Slide*

I understand that I am required to provide these disclosures as part of my ISCTM slide presentation (on title slide or 2nd slide).

Session in Which Presentation Appears*

Phone

This field is for validation purposes and should be left unchanged.

17th Annual Scientific Meeting Speaker Confirmation

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