SPEAKER BADGE & A / V Request

Please complete all sections

SPEAKER BADGE INFORMATION

First Name:
Last Name:
Pronunciation:
Job Title:
Company:
Address:
City:
State:
Postal Code:
Country:
Office Phone:
Cell Phone:
Email Address:

REQUIREMENTS

Session Title:
Session Date/Time:

✓ Laptop Computer
✓ LCD Projector
✓ Screen
✓ Podium
✓ Podium Microphone
✓ Wired Lavaliere Microphone

  No Additional AV Needed
  Audio for PowerPoint
  Flip Chart with pad and markers
Additional Microphones (indicate how many)
Other: