WPA Speaker Request Form

WPA Speaker Request Form
Thank you for your interest in booking a speaker through the WPA Speaker's Bureau. Complete this form to submit your request and allow 3-4 weeks for processing. Please note the WPA Speaker's Bureau serves as a means of connection between Organizations/Events and potential speakers only. WPA does not endsorse any specific person or their presentation material.

Contact WPA@badgerbay.co with any questions.
Name*

FirstLast
Professional Designation*
Email:*
Job Title*
Organization Name*
Event Name*
Event Start Date*

MonthDayYear
Date
Event End Date*

MonthDayYear
Date
Length of presentation*
Morning 8-10amMid Day 11-1pmAfternoon 2-5pmEvening 6pm or laterAny time
In PersonVirtualEither
List your Requested Speaker(s) in order of preference:
Anxiety DisordersChild & Adolescent PsychiatryCommunity PsychiatryConsultation Liaison PsychiatryCultural Psychiatry & DiversityDissociative Identity DisorderForensicsGeriatricsMood DisordersNeurocognitive Disorders (Delirium, Dementia, etc)Neuroscience & GeneticsPersonality DisordersPhysician Well-Being/ BurnoutPractice ManagementPsychopharmacologyPsychotherapy (Behavioral & Psychodynamic)Psychotic DisordersSexual DysfunctionSleep-Wake DisordersSomatic Treatments (ECT, rTMS, DBS, etc.)Substance Use DisordersSuicide & Risk EvaluationTrauma & Stressor Related Disorders (PTSD)Other
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