Fellows Program: Expertise & Marketing Form

Speaker Candidate Nomination Form

Keystone Symposia is committed to delivering balanced conference programming that represents scientific viewpoints and perspectives from across research areas, sectors and career stages. Please assist us in growing our pool of potential speaker candidates by providing the information below. We are particularly interested in nominations of early-career scientists, as well as scientists from Low- and Middle-Income Countries (LMICs).
CANDIDATE INFORMATION

Please complete the fields below to the best of your knowledge. Minimally, we are requesting the candidate's name, current affiliation and primary research expertise.
Name*

First NameLast Name
Candidate's Institution*
Link to Candidate's Faculty/Lab Website
Candidate's email Address
example@example.com
EXPERTISE

Please select a primary expertise for the candidate from the drop-down boxes below. Add keywords to further identify the candidate's background/expertise and include any additional details in comments.
Primary Expertise*
Keyword 1
Keyword 2
Keyword 3
Are you aware of a regularly occuring Keystone Symposia conference topic(s) that fits this candidate's expertise?
Comments on Expertise/Background
Keystone Symposia is dedicated to engaging health equity researchers in discussions that consider how personalized medicine approaches that recognize the variation in human populations can advance precision treatment and better health outcomes.

Check this box if the candidate's primary research applies molecular, cellular, and/or genetic approaches to drive clinical advances for different populations.
Please indicate whether Keystone Symposia should also consider this candidate in any of the following leadership capacities:

Organizer (or conference co-organizer)Scientific Advisory Board member
Please check all relevant demographics that apply for this candidate, to the best of your knowledge:

Early-stage Investigator (i.e., an investigator who has completed their terminal research degree or end of post-graduate clinical training within the past 10 years and/or an Assistant Professor or equivalent)Originates from or resides and works in a designated LMICOther
THANK YOU!

Please complete the fields below if we may contact you regarding this nomination.
Your Name

First NameLast Name
Your Institution
Your email Address
example@example.com
Should be Empty:

Speaker Candidate Nomination Form

CANDIDATE INFORMATION

EXPERTISE

THANK YOU!