SPEAKER NOMINATION FORM
Closing date of the application will be 30/04/2021
The more information you provide, the easier it is for us to make a fair evaluation.
For any issue with the nomination form below, please contact us at summit@greatzambezi.com
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Speaker Nomination Form
Please specify! Who would you like to nominate as a speaker
*
Nominate myself as a speaker
Nominate someone else as a speaker
Nominator Information
Please fill this space even if you are the nominating yourself
Prefix
*
Mr.
Ms.
Mrs.
Dr.
Prof.
First Name
*
Last Name
*
Email
*
example@example.com
Phone Number
*
Country
*
Nominee Information
Prefix
*
Mr.
Ms.
Mrs.
Dr.
Prof.
First Name
*
Last Name
*
Company
*
Job Tittle
*
Job Function or Department
*
Company Focus
*
Country
*
Phone Number
*
Email
*
example@example.com
Website
LinkedIn
Twitter
Facebook
Please Note:
This section must only be used if you are nominating yourself or filling the form on behalf of the speaker. Note that it is REQUIRED
Please enter your biography and areas of expertise here (approx. 200 words)
0/200
Please indicate a topic you would like to present and your position on that topic (approx. 200 words)
0/200
Sub-topics: Please provide between 3-5 bullet points outlining the main points/ issues/ "take-aways" you will cover during your presentation.
Please attach a head shot photo and if possible, your company logo, for use on the event web site when returning this form.
Upload speaker photo
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Upload company logo (if available)
Select File
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Final Few Questions
Please Note:
This section must only be used if you are nominating yourself or filling the form on behalf of the speaker. Note that it is REQUIRED
Please let us know if you would be happy to meet others, on a one to one basis, to share your knowledge and expertise:
Yes
No
Please let us know if you would be happy to take part in/lead any interactive sessions such as roundtable discussions, meet the experts etc.:
Yes
No
Would you be prepared to take part in a short pre-conference interview (by Email, WhatsApp, Call or Zoom) with a member of the Great Zambezi Initiative team (to be used for pre-event PR):
Yes
No
Have you produced any articles, white papers or similar that you would like to share via our event web site, and promoted though our marketing efforts?:
Yes (please attach them below)
No
If yes, please attach them here.
Select File
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Do you have any colleagues that might be interested in receiving information about this event as speakers? If so, could you please enter their email details below so that we can contact them requesting their full details.
Thank you!
Great Zambezi Initiative will keep you informed of future events and content within your field of interest. We will only send you relevant information (by email). Your details will only be held on the Great Zambezi Initiave internal database and will not be supplied to 3rd parties without your knowledge and permission. For more infomation contact our team at
sis@greatzambezi.com
or visit our website
www.greatzambezi.com
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