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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

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

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Chicago, IL 60637