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2021 SPS Virtual Conference

September 18-19, 2021
Brought to you in virtual format

WILLINGNESS TO PARTICIPATE FORM

WP FORM FOR: Benjamin Jackson, MD
If you are not Benjamin Jackson, MD click here | Return to Faculty Forms.

Contact Information

Required fields are marked with an "*".

Name:	Benjamin Jackson, MD
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Academic Institution City/State:
Clinical Position:*
Practicing Institution/Hospital of Practice:*
Preferred Mailing Address:*
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Willingness To Participate/Adherence To Deadlines

I have read the Willingness to Participate information below. These assignments have been made as a result of an invitation to perform the duties as a faculty member for the above-captioned meeting.

Please indicate your participation in the following lectures, workshops, case discussions, and/or as moderator as outlined in the lecture schedule.

Participation	Date		Lecture Title
I am pleased to participate in all lectures, workshops, case discussions, and/or as moderator as outlined in the lecture schedule.
I will participate in this lecture I must decline this lecture	Sat, Sep 18, 2021	*Moderator*	1B: NPO Time for Sedation: Comprehensive literature review

I will participate in this lecture I must decline this lecture	Sat, Sep 18, 2021	*Moderator*	3B: NPO Time for Sedation: Comprehensive literature review

I agree to adhere to all deadlines outlined in my faculty letter/email.

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