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Continuing Education Course Speaker Biographical Information Submission Form

Speaker Name & Contact Information

First Name:
Last Name:
Degree(s):
Department:
Organization:
Address 1:
Address 2:
City:
State or Region:
Country:
Zip:
Email:
Phone:
Fax:


Presentation Title:
CE Course Title:
Materials Description (e.g. text, slides or other):
Photo:
Please upload a portrait-style photograph of yourself, in jpeg format with high resolution (minimum 300 dpi resolution). The photo (head and shoulders) needs to be of appropriate quality. If the headshot portion of the photo, when sized to 3"x5," looks fuzzy, we can't use it. It works best to upload the image as originally taken (not cropped or modified).

Brief Biographical Information (please limit each to 150 words)
Education: List degrees (without punctuation), field, institution name and location, year.

Example:
PhD, Molecular Biology, The University of Sheffield, United Kingdom, 2007 BS, Department of Animal Science, Rutgers University, Cook College, New Brunswick, NJ, 2003
Professional Background:
Copyright Release Statement:
I will not have any copyrighted material or information in my presentation.
I will have copyrighted material or information in my presentation (the Copyright Release Form will need to be uploaded in the Licensing Form for each copyright your are requesting on the following page).

  1. I have read the SOT Code of Ethics and agree with all of the conditions listed within that document.
  2. I acknowledge that all animal experimentation has been carried out in accordance with the Society's criteria for the care and use of animals in research.
  3. I acknowledge that IRB protocol for human testing has been followed and approval obtained.

By checking this box, I indicate my agreement with statements 1-3 above


Submit this material by selecting the "Submit" button and completing the SOT licensing form that appears. If applicable, upload the Copyright Release Form(s) via the Upload additional agreement/release form(s) on the next page.