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* 1. Potential Speaker Information

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* 2. Additional/Preferred Contact Information (If applying on behalf of another individual)

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* 3. Please provide a brief summary of the proposed topic or case study.

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* 4. Please select the preferred format of your talk.

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* 5. Please share any additional information that you think would be relevant for the Conference Team to consider.

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* 6. If you would like, you may attach a brief bio for the speaker or additional information about your organization here.

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