First Name
Last Name
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Job Title
Company
Business Email
Business Phone Number
Mobile Phone Number
Address Line 1
Address Line 2
City
Country United States Canada Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil British Indian Ocean Territory British Virgin Islands Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Croatia Cuba Curaçao Cyprus Czech Republic Côte d’Ivoire Democratic Republic of the Congo Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Honduras Hong Kong S.A.R., China Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao S.A.R., China Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea Northern Mariana Islands Norway Oman Pakistan Palau Palestinian Territory Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Romania Russia Rwanda Réunion Saint Barthélemy Saint Helena Saint Kitts and Nevis Saint Lucia Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Korea South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu U.S. Virgin Islands Uganda Ukraine United Arab Emirates United Kingdom United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Vatican Venezuela Viet Nam Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe
Assistant First Name
Assistant Last Name
Assistant Email
Do you have any accessibility requirements?
Do you have any dietary requirements?
LinkedIn Profile URL** **By supplying your LinkedIn profile, you agree to us using your profile photo on our website and other event collateral.
Bio (Up to 100 words)
If you are presenting alongside others (e.g. you are taking part in a panel discussion) would you like to be introduced by email to the other speakers in your session, along with the session moderator, ahead of the event? Yes, opt in to email introductions No, opt out of email introductions N/A
After the event, your presentation slides will be shared with attendees. Please let us know if you DO NOT want your presentation slides to be shared. No, I do not want my presentation slides to be shared with attendees after the event
Your speaking session at an in-person event may be filmed and recorded, and may be used in further marketing collateral. If you are not happy to be filmed at an in-person event, please tick the box.**** I would like to opt-out of my speaking session being filmed ****The video recording will be hosted on the event organiser's website for at least 30 days following the event, to be accessed by attendees not present on the event days.
If you are contributing remotely, please indicate if you are happy to share your session on-demand?* Okay to upload recording and PDF of sessionOkay to upload recording of session onlyOkay to upload PDF of session onlyDo not make session available on-demandNot applicable *This is only relevant for speakers who will be contributing remotely to the event rather than in-person.
Please list any dates you are unavailable pre-event (i.e. holidays, board meetings) This is to help us for scheduling script run-throughs and/or technical checks ahead of the live event day.
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