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.

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.

* Indicates a required field.

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.

Full Name (First Name/Surname)*

Organisation/Job Title/Department*

Please tell us about your current role

Email address*

As used with your MyFSRH website account.

Topics and Themes for your presentation*

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

Can you share written or video evidence of where you've spoken before?*

Your location*

Nearest city name or region of the UK.

Your telephone number*

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

If you would like a copy of your responses to this form please enter your email address below:

Verification

Click the box

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

Last step

Privacy notice

Become an FSRH speaker

Thank you for your interest in becoming an FSRH speaker.