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Below is the application to be an instructor at the Goldfarb Foundation's 2018 Clinical Conference.  All details for the event are included in this letter, please read the letter in it's entirety before completing the application.  If you encounter issues with the application, contact Lara Beer-Caulfield.

All applications submitted by January 8, 2018 at 9:00 am will be reviewed at the Foundation's January Planning Meeting.  Applications received after January 8will be reviewed on an as needed basis.

Clinical Conference Instructor Application

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  • CONTACT INFORMATION










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  • CREDENTIALS & MEMBERSHIPS












  • FINANCIAL DISCLOSURES


  • If applicable, check which type of disclosure you need to make and then list the relevant names of the companies/organizations.

  • LECTURE PREFERENCES & INFORMATION






  • Complete the information below pertaining to the lecture you would like to present. You must enter the title and description of at least one lecture and are welcome to complete the information for a second lecture.































  • CV UPLOAD

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    • ATTESTATION & SUBMISSION

    • By checking "yes" below and entering your initials, you are signing this application and attesting that you are the speaker applying and not a third party organization submitting the information on behalf of another person.

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    Phone : 717-763-7665
    Fax : 717-761-4091
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    The William L. Goldfarb Foundation 757 Poplar Church Road
    Camp Hill, PA 17011