Kansas City 2018 NMRA Convention - Clinic Request Form

We want to hear about your clinic! Use this form to provide clinic information and contact details.

After we have a chance to review your information, we will get in touch with you to discuss your clinic.

First, let's get some general information about your clinic

Please provide a short description of your clinic (for potential use on the web site or convention timetable). Be as descriptive as you'd like!

Help us categorize your clinic (for sorting and inclusion in the timetable)

Next, let's get some information about how to contact you

What person or persons will be giving the clinic?

If you are affiliated with an organization or business

We need this to get in touch with you.

if any

Next, let's get some specific information about what you want or need to be happy about giving your clinic

Do you have a preference for the day of the week to give your clinic (we will attempt to accomodate this, if possible).

Considering that there will the usual PC, video project, and screen, do you require an special equipment or facilities for your presentation?

What is the general "skill level" of the topic covered in your clinic? This is intended to help the potential clinic attendee understand the depth or complexity of the topic covered in the clinic.

Use this space to provide additional details or comments to help us understand why your clinic is awesome

Use this section to provide any additional information that you think will be useful to the convention clinic committee

Powered by Smartsheet Forms
Privacy Policy   |   Report Abuse
Your submission is being processed. Please do not close this browser window until complete.