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Faculty Information and Travel Logistics Form

Please complete this form so the AOCD can finalize your conference credentials, the printed program booklet, the web syllabus, and your on-site logistics.

Welcome to the AOCD Speaker Resource Center! Please complete your official faculty profile below. The information provided here will be used for your official conference credentials, the printed program booklet, the web syllabus, and on-site logistics.

Phone

This field is for validation purposes and should be left unchanged.

Section A: Personal & Contact Information

First Name(Required)

Legal first name.

Middle Name / Initial

Middle initial or full middle name.

Last Name(Required)

Legal last name.

Professional Degrees & Designations(Required)

DO

MD

PA-C

NP

PhD

FAOCD

FAAD

Other

Select all that apply.

Other Degree / Designation

Please specify.

Preferred Name for Badge

How would you like your name to appear on your printed badge? (e.g., "Bob" vs "Robert") If left blank, your first name will be used.

Primary Email Address(Required)

Main email for official conference logistics and notifications.

Mobile Phone Number(Required)

For urgent on-site communication during the conference.

Office / Work Phone

Direct office line.

Section B: Professional Profile & Affiliations

Primary Practice / Academic Affiliation(Required)

Full official name of practice, clinic, health system, or university.

Current Professional Title / Position(Required)

e.g., Associate Professor of Dermatology, Clinical Director, Managing Partner.

Mailing Address(Required)

Street Address Address Line 2 City State ZIP Code

For official AOCD administrative records.

Administrative Assistant Name

Optional: name of your coordinator or executive assistant.

Administrative Assistant Email

If provided, they will be CC'd on logistics, deadlines, and reminder emails.

Section C: Program Content & Media Uploads

Professional Biography(Required)

Please provide a short professional bio highlighting your background, clinical focus, and major achievements. Word count: 150 – 250 words.

Faculty Headshot Photograph(Required)

Accepted file types: jpg, jpeg, png, tif, tiff, Max. file size: 15 MB.

Upload a high-resolution, professional portrait. Accepted formats: .jpg, .png, .tiff • Minimum dimensions: 250px x 250px • Max file size: 15 MB.

Section D: Travel & On-Site Logistics

Expected On-Site Arrival Date(Required)

Date you plan to arrive at the conference hotel.

Expected On-Site Departure Date(Required)

Date you plan to depart the conference hotel.

Hotel Room Required?(Required)

Yes

No

Do you require a hotel room reservation for the conference?

Number of Nights(Required)

Please enter a number from 1 to 30.

Number of nights lodging required.

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