There is a planned system outage from 8 p.m. on May 1 until 4 a.m. on May 4. The Physician Directory and CPSA Portal (including OATS) will be unavailable during this time. We apologize for any inconvenience.

Speaker Request Form

Request a CPSA representative to present at your next conference, professional development session or event.

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

  • About the Event

  • YYYY slash MM slash DD
  • If multi-day event/conference
    YYYY slash MM slash DD
  • :
  • :
  • Please select all that apply.
  • Please enter a number greater than or equal to 1.
  • In minutes
  • i.e., Interactive/engaging, Q&A, webinar, formal/lecture, PowerPoint)
  • i.e., Are sponsorship dollars required in order to be a speaker?
  • Please list names and organizations.
  • i.e., Headshot and/or biography of speaker, CPSA logo and/or boilerplate, trade show booth set up, promotional items.
  • YYYY slash MM slash DD