2021CosDoc Abstract/Presentation - Expression of Interest

Please use this form if you would like to be a presenter at one of the sessions in our annual online conference - CosDoc2021. All expressions of interest welcome - closing date is yet to be advised. Please allow 2 to 3 days for us to acknowledge receipt of your submission. Thank you. Any questions, please call WA on 0407 788 587 or email Julie at cpca@cpca.net.au

Speaker's Last Name*

Speaker's First Name*

Speaker's Email*

Speaker's Mobile #*

Where will you be based on 6th June 21

Should your abstract be accepted, we will require you to be available for a live Q & A session on Sunday 6th June 21. For the purpose of managing time differences, can you please provide enough details of your location to assist us with scheduling your presentation and Q & A session. More information will come as we go through the process. Thank you.

Speaker's Website

Speaker's Facebook Page

Speaker's Twitter

Speaker's Linked In

Presentation Title*

Short Description on Presentation Content*

An extended abstract can be uploaded via the facility at the end of this form. Thank you.

Duration of Current Presentation

Declaration of Conflict of Interest

Patient Consent Obtained?

File Upload

Check List - CV, Bio and/or Credentials - Head & Shoulders framed photograph, JPG or PNG, 500px x 500px - Extended Abstract If file size is a problem, please send your file via alternative methods to cpca@cpca.net.au

Drag and drop files here or

File Check List

Speaker's CV, Bio, Photo &/or Credentials Provided

Please confirm you have uploaded your CV, short bio, photograph and/or credentials via the upload feature at the end of this form. Thank you.

Abstract Uploaded*

Please confirm you have uploaded your abstract. Thank you.

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