Speaker Nomination FormPrimary InfoActivity Title* Activity Title*Date of Activity* Date of Activity*Target Audience* Target Audience*PhysiciansNursesPharmacistsAllied Health ProfessionalsStudentsLab TechniciansOther:Proposed Speaker Name* Proposed Speaker Name*Email* Email*Speaker Selection CriteriaQuestion* Question*Meets StandardNeeds ImprovementAcademic QualificationsProfessional ExperienceTeaching / Presentation SkillsCommunication SkillsPrevious CPD / Training ExperienceReputation & Peer FeedbackAlignment with Learning OutcomesUpload Speaker CV* Upload Speaker CV*Add fileThis type of file isn't allowedThe file size must be up to 5 MB