Membership Application ⇽ Event Speaker

Glue Up account creation information.

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Profile Photo

Please enter a first name

First Name *

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Please enter a last name

Last Name *

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Please enter a valid email address
e.g. john.doe@glueup.com

Email Address *

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・8 characters minimum
・one upper case letter
・one lower case letter
・one number
・one special character (@$!%*?&)

Password *

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・8 characters minimum
・one upper case letter
・one lower case letter
・one number
・one special character (@$!%*?&)

Confirm password (at least 8 characters) *

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Please fill in your member application details.

Please enter a first name

First Name *

If you input more than 0 characters your First Name may not display properly

Please enter a last name

Last Name *

If you input more than 0 characters your Last Name may not display properly

Please enter a valid email address
e.g. john.doe@glueup.com

Email *

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Please enter a valid phone number including country code

Phone

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Please enter a valid phone number including country code

Mobile Phone

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Company

Title/Position

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Provide a brief professional biography. (Under 200 words)

Speaker Biography

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Address

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City

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State/Province

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Please Select Valid Province Value

State/Province *

Please Select Valid Province Value

State/Province *

Country/Region

Postal Code/Zip Code

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Industry

Proposed Session

Please enter a session title

Session Title *

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Session Type *:

Test Group

Select one or more options

Please enter a session objectives

Session Objectives *

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Session Overview/Description

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Has this topic been presented at any other conference or webinar in the last three years?YesNo

Event of InterestConferenceWebinarOther

Please enter a value for the other option. The value cannot exceed 255 characters.

Panel Discussion *YesNo

Select one or more options

Names of Additional Speakers (Limit 3)

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Social Media Platforms

Please enter a valid LinkedIn link e.g. "https://www.linkedin.com/in/userid"

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Please enter a valid Twitter link e.g. "https://www.twitter.com/name"

Twitter/X

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Please enter a valid Instagram Link e.g. "https://www.instagram.com/username"

Instagram

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Please enter a valid Facebook link e.g. "https://www.facebook.com/yourname"

FaceBook

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Membership Refund Policy

Glue Up account creation information.

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