Request a speaker Interested in having a Speaker present for your neurosurgical patients or physicians? Submit the form below to request a Speaker for your event. Speaker Request Form Request a Speaker Thank you for choosing to contact the University of Chicago Medicine. Please use the below form to request a speaker for an event. Are you requesting a Speaker for a physician-focused event, or for a patient-focused event? * Physician-focused Event Patient-focused Event Will this event be CME accredited? * Yes No What would you want this Speaker to discuss? * CNS Congenital Anomalies (General Overview) Chiari Malformation Hydrocephalus Craniosynostosis Syringomyelia Spina Bifida What would you want this Speaker to discuss? * Chicago Public School Resources (IEP, 504 Plans, etc.) Medicaid Adaptive Sports Programming Navigating the Hospital (Scheduling an Appointment, Obtaining Medical Records, etc.) Patient Advocacy Name * Email * Phone This form is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply. Submit