Become an FSRH speaker

Thank you for your interest in becoming an FSRH speaker.


Please give us some details for us to contact you on and also some potential themes or topics for your talk. 

If you would like a copy of your responses (which can be useful, should you apply for other things in the future), please add your email address in the relevant field at the bottom of this form.

The information you have shared on this form will be used by the relevant FSRH Committee and FSRH staff for the purposes of administration only. FSRH will keep this information securely on our systems. Our full privacy policy can be viewed here.

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Your Contact Details

Please give us your contact details. We may get in touch later if we have any further questions as a result of your feedback.

Please tell us about your current role

As used with your MyFSRH website account.

Please suggest topic(s) and/or theme(s) for your potential presentation or talk idea.

Nearest city name or region of the UK.

This should be the number that we can easily reach you on or leave you a message on.

Verification

Please click the box to indicate you are a human rather than an automated system completing this form.

Last step