Request Form: To Become an IPPF Speaker

Request Form: To Become an IPPF Scientific Speaker

Thank you for your interest in becoming an International Pemphigus & Pemphigoid Foundation (IPPF) scientific speaker. Our speakers have considerable experience lecturing on pemphigus and pemphigoid, as well as seeing patients with pemphigus and pemphigoid. Many of our speakers are academic professors of oral pathology / medicine / periodontology, Diplomates of the American Board of Oral and Maxillofacial Pathology, and Fellows of the American Academy of Oral and Maxillofacial Pathology. If you have similar qualifications and would like to be considered, please fill out the form below and someone from the IPPF will follow-up shortly to discuss this opportunity further.

1. Please answer the following questions:

First Name *This question is required.

Last Name *This question is required.

Degree(s) *This question is required.

Email Address *This question is required. This question requires a valid email address.

Phone Number *This question is required. This question requires a valid number format.

City *This question is required.

State *This question is required.

Organization/Institution *This question is required.

Position *This question is required.

List if you are Diplomate, Fellow or member of any speciality associations. Please be specific.

Please provide a short bio below to help us better understand your background and experience with pemphigus / pemphigoid. *This question is required.

How far would you be willing to travel to present? *This question is required.

Do you require an honorarium? *This question is required.

Please enter an 'other' value for this selection.

Why are you interested in speaking about pemphigus and pemphigoid? *This question is required.

Please use the space below to provide any additional information you'd like to share with the IPPF.