CogX 2017 - Speaker Application Form
At CogX, there will be a mixture of:

Panel opportunities with a 5 minute presentation

Please fill in this form as completely and accurately as possible. All required fields are marked with *

First Name
Your answer
Last Name
Your answer
Job Title / Role
Your answer
Organisation
Your answer
Speaker email address
Your answer
Speaker personal phone number
Your answer
Office phone number
Your answer
Assistant / PA email address
Your answer
Assistant / PA phone number
Your answer
Dates available to speak at CogX 2017
Required
Brief speaker bio (max 100 words)
Your answer
Top 3 topics of interest
Required
What would be the title of your talk?
Your answer
Please share a brief abstract on your talk (max 150 words)
Your answer
Brief organisation / company description (max 50 words)
Your answer
Spoken publicly before? If so, where?
Your answer
Please provide links/urls to video/audio featuring speaker
Your answer
Please provide any links/urls to articles or web pages about the speaker
Your answer
Organisation / company website url
Your answer
Submit
Never submit passwords through Google Forms.
This form was created inside of CognitionX. Report Abuse - Terms of Service - Additional Terms