ENTELEC Panelist Participant Opportunities Panel Discussion Opportunities*By completing this form you are communicating to ENTELEC your interest in participating in (or moderating) a panel discussion at the ENTELEC Conference. This information will be used by the ENTELEC Technical Committee to organize panel discussions and gage topics of interest to bring to the event. This is not a guarantee that you will be on a panel. These discussions are generally 1 hour in length. Yes, I understandName* First Last Company Name*Job Title*Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Phone*Please list the phone number best to reach you on. (This number will not be published.)Email* Enter Email Confirm Email Bio*Provide a concise and grammatically accurate 5-7 sentence biography. THIS MAY BE USED FOR INTRODUCTIONS AND MARKETING PURPOSES. Not to exceed 500 characters.Photo*Please make sure that your photo is no larger than 300 x 300 pixels.Accepted file types: jpg, png, tif, gif, Max. file size: 6 MB.Tell us your preferred topic of expertise.Let us know what panel discussion topic you would like to participate in at ENTELEC. What is your topic of expertise?Are you interested in Moderating a Panel Discussion?*Would like to organize and moderate a panel discussion to be considered at ENTELEC? This would involve bringing together a panel of 3-6 industry experts to discuss a topic of importance at ENTELEC. Yes - I would like to moderate and organize a panel No thanksIf you would like to moderate and organize a panelTell us the topic of your proposed panel discussion below. List the names/companies you plan to invite to participate on your panel. (We understand that getting participants to commit may take time, so confirming these participants can come later.)Please provide and additional comments below.If you are completing this form for someone else, please complete the information below.Or additional contact person other than speaker – If there is an additional contact for this speaker/instructor please list their contact information.Name of Additional Contact First Last Phone Number of Additional ContactEmail of Additional Contact Enter Email Confirm Email Please click on the Submit button below to finishThank you for submitting to speak at the ENTELEC Fall Seminar. The Technical Committee will be reviewing all submissions and you will be notified later this summer if your session was accepted to be part of the educational line up for the Fall Seminar.Section Break