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Sowing Our Seeds: Empowerment Convergence - Speaker Registration Form
Dear Speaker,

Thank you for your interest in participating as a speaker at the Sowing Our Seeds: Empowerment Convergence. Your expertise and insights are invaluable to our event's success. Please complete the following form to facilitate your registration:
Professional Information:
Full Name:*

First NameLast Name
Professional Title:*
Company:*
LinkedIn Profile:*
Business Contact Information:
Email:*
example@example.com
Phone Number:*
Please enter a valid phone number.
Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Presentation Details:
Upload Head Shot (JPEG/PNG, max 5MB):*

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Presentation Title:*
Introduction *
Keywords (relevant to your presentation):*
Aim of the Speech *
Learning Objective*
Biography: (Please cut and paste your biography here)*
Speaker Release Statement:
Equipment Needed:
Microphone:
Laptop/Clicker:
Laptop
Other (please specify):
Note: Note: Please ensure that all information is accurate and complete. Incomplete forms may affect your registration. Upon submission, you will receive a confirmation email with further details. Thank you for being a part of Sowing Our Seeds: Empowerment Convergence! We look forward to your impactful contribution.
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Sowing Our Seeds: Empowerment Convergence - Speaker Registration Form