Presenter Information Form

Title

Name

First Name

Last Name

Organisation

Position

Phone

Country

(###)

###

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Bio

Please provide a 50-100 word bio for marketing and introductory purposes

Presenter Headshot

Please provide us with a headshot for marketing purposes

Usage Consent

Without expectation of compensation or other remuneration, you provide consent to use your image and/or presentation or statements made in connection with the ASGO ASM, in its publications, virtual conference portal (if necessary), advertising or other print or electronic media activities including the Internet.
This consent includes, but is not limited to:
A) Permission to use your name, title, and firm/organisation name
B) Permission to share a PDF of your presentation with delegates post conference

Yes

Disclosure

Please list any existing or known future financial relationships or commercial affiliations