MSRC 2025 Speaker Submission

MSRC 2025 Conference Lecture

Completing the below information will allow the Massachusetts Society for Respiratory Care P&E Committee an opportunity to review your proposal for our 2025 Conference.
Have you provided this lecture previously for the American Association for Respiratory Care?

YesNo
Contact Information
Full Name*
Credentials (i.e. RRT, MD, DO, etc. )*
Email*
example@example.com
Phone Number*

Area CodePhone Number
Preferred Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Current employer*
Current position ( title )*
Lecture Information
Title of your talk*
Leaner Objectives:

Only one objective is required. Please be brief and concise.

For example, for a lecture on COPD you may write "After attending this presentation, the learner should be able to identify the signs and symptoms of a COPD exacerbation."
Objective (s) of your talk*
Give a brief biography of yourself. This may include professional and/or personal information. The Room Moderator will read this as your introduction. (100 wordlimit): *
Briefly, what is your expertise in relation to the topic (i.e. years’ experience in the field or relevant work experience)? *
Declaration of Vested Interest: An individual involved in the planning of or presentation of an educational activity may have an interest in or affiliation with an organization but the audience must be informed of this relationship before the presentation of the activity. For this purpose, a real or apparent conflict of interest is defined as personal gain or benefit derived from involvement with any entity, product or service. Vested interest includes but is not limited to employment, owning stock, inclusion in a speakers’ bureau, or a relationship, personal or otherwise, with a company that could potentially provide you a benefit from the relationship.
I recognize that I must follow all criteria regarding vested interest and declare that*

No, I have no real or perceived conflicts of interest that relate to this presentationYes, the following is a real or perceived conflict of interest that relates to this presentation ( explain below )
Explanation of real or perceived conflict of interest
Should be Empty:

MSRC 2025 Conference Lecture