Convention Planning Committee Contact Information Form

Thank you for taking the time to input your details. The information collected through this form is for the use of the Convention Planning Committee members. Contact information such as email addresses and phone numbers will not be published on the website.

Information provided in this form will be used “as is written” so please ensure that any company names or titles are accurate and written in full.

First Name*

Last Name*

Preferred Name

Company Name*

Position

Email address*

Cell phone number

City / Province of residence

Country of residence

Entered Industry [Alma mater, Degree,] Year

Postgrad: Degree, University, Year

Thesis Title

Areas of expertise

Involvement at PDAC

PDAC awards

Other relevant volunteer experience

Other awards/honours

Professional affiliations