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* 1. Speaker Full Name:

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* 2. Title:

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* 3. Company:

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* 4. Email:

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* 5. Cell phone:

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* 6. What city are you located in?

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* 7. Speaker Bio:

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* 8. Please select the main topics your session will cover:

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* 9. Presentation Title

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* 10. Presentation Description:

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* 11. If you require an honoraria/speaker fee please indicate your rate:

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* 12. Are you interested in exhibiting at the show?

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* 13. Any general comments?

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