Registration Form
Title:
First Name: *
Last Name: *
Position: *
Company: *
Address:
City:
State:
Post Code / Zip:
Phone: *
Email: *
Country: *
 
  Nominee Title  
     
 
  Nominee First Name  
     
 
  Nominee Surname  
     
 
  Nominee Job Title  
     
 
  Nominee Organisation/School  
     
 
  Nominee Email  
     
 
  Nominee Phone  
     
 
  Proposed topic: what subject/theme do you think this person should speak about? *  
     
 
  Background: Tell us briefly about the recommended speaker: Why are you recommending him/her? Occupation? Major achievements? Recent activity or work? Honours or recognition? *  
     
 
  Justification: Why do you believe our audience would be interested to hear from this person? *  
     
 
  Proof: Please provide links to any articles, videos presentations *  
     
 
  References: Does this person have any referees who can vouch for their suitability, ability and presentation style? *  
     
 
  Experience: Has this person spoken publically before? Where and when? *  
     
 
  Eligibility: Does this person work for a Vendor/Supplier/Consultancy OR an end-user? (Note: preference is given to end-users. An example of an ‘end-user’ is a Principal of a School OR a Vice-Chancellor from a university i.e. this person uses technology, but does not sell technology) *  
     
 
  Category: What category of speaker do you think this person is? [Keynote, Inspirational, motivational, practical advice, case study, panelist, chairperson/moderator, other] *  
     
 
  Intellectual Property: Can we get permission to video record and publish this presentation after the live-event? *  
 
Yes
 
 
No
 
 
  Vendor relationship: Is this person involved with/related to any company, product or service which may gain financial benefit from presenting a paper? *  
     
 
  Which conference is this person nominated for? *  
   
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