Speaker Suggestion Form Please complete the nomination form below Name of person making the nomination * Name of person making the nomination First First Last Last Email Address * The SRF Secretariat may contact you if there are any further questions, or problems contacting the person you have suggested. Name of Nominated Speaker - self nominations welcome * Name of Nominated Speaker - self nominations welcome First First Last Last Email Address * Phone Number - no spaces * To the best of your knowledge is the above person a member of SRF? * Yes No Please indicate which conference you are suggesting a speaker for. * FertilityWCRBOther Please indicate which conference you are suggesting a speaker for. Proposed topic of the talk * • Please explain why the named person should be considered to represent SRF as a speaker? Maximum 250 words * • Has the named person been an invited speaker for SRF or SSR in the last three years? * Yes No Please give details if known. Captcha If you are human, leave this field blank.
