Speaker Application for 2025 Symposium – Virginia Society for Respiratory Care

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Position You're Applying For

Area of expertise/lecture topic

critical care

neonatal/pediatrics

sleep

PFT

mental health/wellbeing

Other

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Give a brief description of your lecture, points of interest, your background on the topic and any other pertinent information.

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Conflict of Interest(Required)

An individual involved in the planning of, or presentation of, an education activity may have an interest in or affiliation with an organization, but the audience must be informed of this relationship before the presentation of the activity. For this purpose, a real or apparent conflict of interest is defined as personal gain or benefit derived from involvement with any entity, product or service. Vested Interest includes (but is not limited to) employment, by owning stock, from inclusion in a speakers’ bureau or a relationship, personal or otherwise, with a company that could potentially benefit from the relationship. I recognize that I must follow all criteria regarding vested interest and declare that: MARK ONLY ONE.

I have NO conflicts of interest

I HAVE a conflict of interest

Conflict of Interest Disclosure Statement

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