Your name *

First Name

Last Name

Is this request for a virutal or in-person presentation / offering? Note: in most cases only virtual offerings will be able to be accommodated *

Virtual

In person

No preference

What type of offering are you requesting? *

Presentation

Interview / Q&A

Speaker's Panel

Other

In most cases, our presentations / offerings are delivered by a member of our early career network along with a more senior member of the CPA. Please specify if you have a preference. Note we may not be able to accommodate your preference. *

Prefer a combination of early career psychiatrist and more senior psychiatrist

Prefer early career psychiatrist(s) only

Prefer senior psychiatrist(s) only

No preference