Global Genes Speaker Recommendation Form

First Name

Last Name

Professional/Educational Designations

Title

Company/Organization/Affiliation

Phone

What rare disease(s) do you represent?

How long have you been involved in rare diseases?

Less than 1 year1-5 years5-10 yearsMore than 10 years

Are you submitting this recommendation on behalf of yourself or someone else?

I am recommending myselfI am recommending someone else

Please include the recommend speaker's information here (if submitting on behalf of another person).

First Name

Last Name

Professional/Educational Designations

Title

Company/Organization/Affiliation

Phone

What rare disease(s) do you represent?

1. How long have you been involved in rare diseases?

Less than 1 year1-5 years5-10 yearsMore than 10 years

2. Please select a method for submitting the speaker biography here.

Upload documentType or copy/paste directly

Please upload the speaker biography here.

Please enter the speaker biography here.

3. What event are you most interested in presenting?

RARE Drug Development SymposiumRARE Patient Advocacy Summit RARE Health Equity SummitOther/I don’t know

Proposed Presentation Topic & Overview

4. Have you presented this topic already this year and/or do you anticipate this topic being presented before this event?

YesNoUnsure

Please include any additional information or links relevant to your work and past presentations here that you think would be helpful to the review committee.

Terms & Conditions:

If selected as a speaker, I agree to:

To complete all speaker paperwork and registration materials within two weeks of confirmation and no later than (10) business days prior to the event
To respond to organizer emails in a timely manner and provide requested materials as needed (bio, headshot, etc.)
To participate in virtual prep calls with organizers and other speakers/co-presenters
To use the Global Genes branded slide deck for any presentation decks; exceptions may be discussed directly with the organizers
To attend the program/event, including presentation, Q&A and networking times
To ensure that no sales or product pitches are included in my presentation and that all materials are educationally focused
To notify Global Genes as soon as possible if I am no longer able to participate in the program and recommend a suitable substitute if possible

I have read and understood the terms and conditions.

Yes