Clone of ASI 2019 Employee Form

This form is for limited distribution to employees only.
First name*
Last name*
Operating brand*
Other operating brand*
Position*
Job Title
Country*
Office Base
Email*
example@example.com
Mobile phone*

Country CodeArea CodePhone Number

Conference options
Please select which conference you would like to attend. Each day starts at 09:30 (London time).
Day selection*

TV & Video (2-5 November)Radio & Audio (1 Nov) & TV & Video (2-5 Nov)
Who will you be attending with?

Individually (on my own)In the office (with colleagues)
Please upload a portrait photo. We will provide this to ASI for the conference app and delegate materials.
Attendee Photo*

Browse Files
jpeg or png only Cancelof

Confirmation
In submitting this form I confirm that:
- I have the designated authority to authorise the attendance of the named person to the ASI Conference on behalf of my operating brand.
- I have the approval of my line manager to attend as a member of the Kantar delegation authorised to attend the ASI as a representative of my business unit/region.
Should be Empty: