2024 MMEA Clinician | Biographical Information Form

January 22-27, 2024
Tan-Tar-A Conference Center

2024 Clinicans & Presenters

biographical Information Form

DEADLINE: November 6

Clinic/Session Information
Clinic Presentation for (MMEA Area):*
Title of Clinic/Session*

Please enter the TITLE of the session exactly as you wish it to appear in MMEA Conference publications.
Clinician/Presenter Information
Clinician/Presenter Name*
First Last
Please enter your name exactly as you wish it to appear in MMEA Conference publications.
Clinician Email*
Clinician/Presenter Role*
- I am the primary clinician/presenter for the session.
- I am a co-presenter for the session.
BIOGRAPHY SUBMISSION OPTIONS:
1. You may type or “cut & paste” directly into the form field below.
2. You may upload your biography through the document upload field below.
1. Biographical Information
Please limit your bio information to a maximum of 175 words.
NOTE: MMEA reserves the right to edit bio information, as needed.
2. Upload Biography Document
Max. file size: 456 MB.
Please limit your bio information to a maximum of 175 words.
NOTE: MMEA reserves the right to edit bio information, as needed.
Name
This field is for validation purposes and should be left unchanged.