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Speaker Badge & A/V Request

Speaker Badge Information

* Required

First Name:

Last Name:

Pronunciation:

Job Title:

Company:

Address:

City:

State:

Postal Code:

Country:

Office Phone:

Cell Phone:

Email Address:

Session Title:

Session Date/Time:

Conference rooms will be equipped with the following:

Please indicate additional equipment needed for your presentation:

No Additional AV Needed

Audio for PowerPoint

Flip Chart with pad and markers

Additional Microphones (indicate how many)

Other: