Name First (as printed on passport)*
Name Last (as printed on passport)*
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Company*
Phone Number*
Email*
Job Title*
Date of birth*
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Do you have any mental or physical impairments of which we should be aware or which require any special arrangements during the live event?
Anything else we should know to make it a great experience?
What is your preferred departure/ arrival airport? (Flights are with EasyJet from Gatwick and Luton but we can investigate regional hubs as well)
Please share any key topics / challenges or content streams you would like the programme to include?
What is your preferred method of facilitation of these conversations? eg: peer to peer discussions / external speakers / workshops / experiences
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Emergency Contact Full Name*
Contact number in case of emergency*
Emergency Contact Relationship*
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