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SPEAKERS INFORMATION FORM

Name *
Name
Please enter your full legal name
Name *
Name
Please enter how you would like your name to appear in our program. Please also include your title, for example: Jane Doe (Ms./Mrs./Dr./etc.)
Phone *
Phone
Please enter the phone number that we can use to reach you.
T-shirt Size *
All of our T-shirt sizes are unisex
Your Guest
Your Guest
We will reserve one seat for your guest in this event. Please enter their name here. Each speaker can have only one guest. If you would like to waive this opportunity, please leave these fields blank.
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