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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: Amy Vinson, MD, FAAP
If you are not Amy Vinson, MD, FAAP click here | Return to Faculty Forms.

Contact Information

Required fields are marked with an "*".

Name:	Amy Vinson, MD, FAAP
Academic Title:
Academic Institution:
Academic Institution City/State:
Clinical Position:*
Practicing Institution/Hospital of Practice:*
Preferred Mailing Address:*
Phone Number:
Fax Number:
E-mail Address:*
Admin Assistant Name:
Admin Assistant Phone:

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	Impact of COVID-19 Pandemic on Academic Careers

I will participate in this lecture I must decline this lecture	Sat, Sep 18, 2021	1A: Provider Burnout and Creating a Culture of Support

I will participate in this lecture I must decline this lecture	Sat, Sep 18, 2021	3A: Provider Burnout and Creating a Culture of Support

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

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