Speaker Form

YOUR IDEA / STORY

Title of your presentation / story / paper *

Brief abstract (less than 50 words) and/or a research paper abstract *

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YOUR SPEAKING ENGAGEMENTS

Please supply us with up to three links to recent speaking engagements *

Please supply us with any recent articles, blogs, social media about you or written by you *

Please tell us about any honours won, awards or prizes (Nobel, Oscar, Tony, Webby, etc.) *

Please supply us with a reference (first name, last name, company, email, phone number) *

YOUR CONTACT INFO

First Name *

Last Name *

Title *

Email *

Company / organization *

Phone *

Mobile *

Website *

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Chose one speaking opportunity *

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SPEAKER CONSENT

Please read this speaker consent statement carefully *