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* Name (as you'd like it entered on our website and program)

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* Email

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* Phone number

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* Point of Contact (other than yourself)

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* Point of Contact phone number

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* Point of Contact email

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* Best contact methods (select all that apply)

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* Your job title/role

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* Your company's name

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* Your website's homepage

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* Your LinkedIn page

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* Your Facebook page

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* Your brief bio (no more than 5-6 sentences please)

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* A high resolution (300 ppi) headshot

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.
Choose File

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* A high resolution company logo

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.
Choose File

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* If the title of your session has already been defined, please list it here. Otherwise, please suggest one

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* If applicable, please input a 2-3 sentence description of your topic as you'd like it written in the agenda

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* Please input 2-3 key takeaways you hope the audience will learn from your participation

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