First Name*
Last Name*
Institution/Company/Organization*
Title
Phone Number
Email Address*
Address 1*
Address 2
City
State*
Zip
Country* Select CountryUnited StatesCanada---Other
Speaker's Bio*
Proposed Topic-1
Topic-1 Description
Proposed Topic-2
Topic-2 Description
What makes your perspective on this topic unique?*
What is the most compelling story that should be told at this event?*
By completing this form, I confirm that I am available to speak at LMD-2025 and understand that I am responsible for my own hotel and travel arrangements.* I Agree
Yes, I would like to receive emails from LMD-2025 about: Additional speaking opportunitiesAttending LMD-2025Exhibiting at LMD-2025
Please provide a link to any social media accounts you are active on.
What is your tweeting/retweeting frequency on Twitter? More than once a dayA few times a weekA few times a monthLess frequentlyI don't use Twitter
What is your posting frequency on Linkedin? More than once a dayA few times a weekA few times a monthLess frequentlyI don't use Linkedin
Please select any of the following other social platforms which you use at least once a month: Facebook / Weibo / VK / Periscope or another social activity sharing siteInstagram / Snapchat / Pinterest / Flickr or another image sharing siteYouTube or another video sharing siteReddit / Quora or another question-answering site
Which of the following are you currently involved with? I advise one or more venture capital or angel firms.I participate in a business or technology incubator.I participate in a university-based advisory board.I participate on an expert panel hosted by a commercial firm.I participate as an adviser to federal, state or local agencies or officials.
Any events have you attended in the past five years?
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