Thank you for your willingness to speak at the 2027 Winter Symposium, January. Please fill in your info below and a NOMA board member will confirm if you are added to the speaking schedule.

First Name *

Last Name *

Email *

Phone *

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Where did you attend medical school? *

Where did you do your residency? *

Board Certification *

Name of your practice *

Please provide a short bio that we may use to introduce you. *

Presentation Title/Description *

On-Site/Virtual Presentation *

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