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CALL FOR SPEAKERS

Thank you for your interest in speaking at this year's Forum! Please complete
the below information. (Deadline for submission is January 31st.)

Are you interested in speaking at Forum, or are you submitting on behalf of
someone else? *

Speaker's First Name *

Speaker's Last Name *

Designation (e.g. MD, PhD, MBA)
 * 
   {name}


Job Title *
(no abbreviations)
 * 
   {name}


Organization *
 * 
   {name}


Email Address *

Phone Number *

LinkedIn Profile *

Describe proposed presentation (100 words max): *
 * 
   {name}


Describe speaker's areas/topics of expertise: *
 * 
   {name}


Additional Comments
 * 
   {name}



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