ASTRO Educational Activity Presenter Form

Thank you for serving as a presenter for an ASTRO educational activity.

You don't need to log in to complete this form, but logging in with your ASTRO credentials will allow you to save the form and return to it, if needed. Once logged in, you will see a Save Draft button at the bottom of each page. To return to the form, log in to the ASTRO Academy and paste the URL for the form, https://academy.astro.org/content/astro-educational-program-presenter-form, into your browser tab.

Please contact ASTRO eLearning with any questions.

Presenter Information

Presentation Title *

Name *

Please enter your name EXACTLY as you would like it to display in activity materials and promotion. Please include professional suffixes (e.g, MD/DO/PhD).

Email *

Affiliation *

Please enter your institution(s)/practice name EXACTLY as you would like it to display in activity materials and promotion.

Primary Employer *

Primary Employer Other

Occupation *

Professional Title(s) *

[e.g., Associate Professor / Director of...]

Cell Number *

If you are participating in a live activity, please provide your cell number. This would only be used if ASTRO needs to reach you urgently (e.g., technology issue).

Assistant Contact

If you would like an assistant copied on scheduling communications, please provide their name and email address.

The information above will be used for your activity role. If you would like to make permanent changes to the information in your ASTRO profile, please visit MyASTRO.

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ASTRO Educational Activity Presenter Form

Presenter Information