Intake Speakers Inspiration Week

Speakers Intake form Inpiration Week

We would like to ask you, as a speaker, to fill out the form below. It is appreciated if you fill in all fields, thank you. For any questions please contact bITa Center by calling Tel. +31 23 2010204
Week of Inspiration 2011
  Male Female
First Name:
Second Name:
Titel(s):
Organisation:
Function:
Address:
ZIP code:
City:
Phone:
Mobile:
Fax:
E-mail:
Name secretary:
E-mail secretary:
   
Title presentation:
(max 20 words)
Subtitle:

Bio:
(max 50 words)
Content:
(max 100 words)
+ Format:
 (keynote, interactief, workshop, etc)
   
Differentiator:
What is unique, different etc. in your presentation?
Photo
 Please be so kind to also email your photo (high resolution if possible to info@weekvandeinspiratie.nl

Necessary presentational equipment:
(beamer, pointer, mic. etc.)

Name on badge
Function on badge
Additional speakers at a workshop
Availability:
during the week of inspiration 		 Please select the days of your availability
Monday 26-9-11 morning afternoon
Thuesday 27-9-11 morning afternoon
Wednesdayg 28-9-11 morning afternoon
Thursday 29-9-11 morning afternoon
Friday 30-9-11 morning afternoon
Other: