Speaker Registration Form

Speaker Registration

You are :

Company information :

Name* Address*

Zip Code City*

Country* Website

Registration :

Gender* : Mr Mrs

Family Name : First Name :

Email : Confirm Email :

Job Title :

Tel : Mobile :

Regional Committees Meetings (12-13 October 2019) :

I will attend the Committees Meetings :

Yes

If yes, please specify :

S & F

S & T

Social Tour 14 October 2019 :

I will attend the Social Tour :

Yes

Accompanying person (Spouse, family, partner, etc) €150 per person (only for social Tour & Gala Dinner)

First Name : Family Name :

* Mandatory Box

Biographie

Biography (200 words)

Photo :

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