1

Personal Data Speaker

2

Details of presentation / photo and brief vita of speaker

Salutation: *
Title:
First name: *
Last name: *
Company/organisation: *
Function:
Address:
Postcode:
City:
Country:
Phone: * Please indicate with country code (+49 179 123456)
E-Mail: * Please provide us with your e-mail address so that we can use it for internal communication.

* required fields

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