SLC6A1 Connect 2026 International Scientific Symposium and Family Conference - Speaker Form
Please note that all sessions will be recorded and recordings will be shared following the conference on the SLC6A1 Connect website as well as our YouTube Channel. If you have any questions or concerns, please do not hesitate to reach out to us at lbermingham@slc6a1connect.org. Thank you!
Full Name
*
First Name
Last Name
(PhD, MD, etc.)
Email Address
*
example@example.com
Cell Phone Number
*
Please enter a valid phone number where you can be contacted during the event.
Format: (000) 000-0000.
Jacket Size
*
Date of Presentation
*
Thursday, 12/3/26 Scientific Symposium
Friday, 12/4/26 Family Conference
BOTH
Please note that all sessions will be recorded and recordings will be shared following the conference on the SLC6A1 Connect website as well as our YouTube Channel.
*
Yes, I agree to have my recorded presentation on the SLC6A1 Connect website and available to the public.
I prefer to have my recorded presentation available only to SLC6A1 families on their private YouTube Channel.
I prefer not to have my recorded presentation available as it contains unpublished data.
Do you agree for your abstract to be utilized by SLC6A1 Connect for the purpose of grant applications (e.g. Simons Searchlight, etc.)
*
Yes, I agree.
No, I do not agree.
Typed Name for Electronic Signature
*
Please type your name as an electronic signature.
Company/ Organization
*
Presentation Title
*
Please provide your organization or institutional logo in both JPEG and high-resolution formats.
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Please upload a logo we can use to promote your session.
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Short Bio
*
Presentation Abstract/Summary with Objectives
*
Please upload your headshot and/or bio here.
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Is there anything else you would like us to know, or do you have any questions for our team?
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