Panel Discussion Form

Panel Discussion Opportunities*

By completing this form you are communicating to ENTELEC your interest in organizing (or participating on) a panel discussion. The panel discussion MUST include end users / operators. The discussions should help solve industry challenges. 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 your panel will be selected, or that you will be on a panel. Panel Discussions will run 45 minutes to 1 hour in length. Most Panel Discussions will take place in the Exhibit Hall Technical Theatre Rooms on Wednesday and Thursday of the event.

Yes, I understand

Name*

First Last

Company Name*

Job Title*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

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 (This number will not be published.)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 Panel Topic / Title*

The title of your panel is important. This should draw attendees to your panel discussion. Please make sure it is short but concise and communicates what the discussion is about. (If you just want to be a panelist, please indicate your topic of expertise below)

Who will Moderate this Panel Discussion?*

Tell us who will be moderating this panel discussion? This would involve bringing together a panel of 3-6 industry experts to discuss a topic of importance at ENTELEC, and guiding the conversation.

Yes - I will moderate and organize this panel
No - someone else will moderate this panel, I just want to be considered as a panelist

If you answered "No" tell us who you feel would be a good moderator for this panel discussion (include email info is possible)

Provide a Brief Description of the Panel Discussion*

Please provide a brief description of your panel discussion. This may be used to communicate the topic and focus of this discussion. It should be concise and create interest from possible attendees. (If you are just wanting to be considered as a panelist - please provide some questions you would like to be addressed during the panel discussion.)

Who will you target to be on this Panel Discussion (or who do you suggest the moderator contact for participating on the panel discussion)*

List the names/companies and email info if possible, for who 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 Contact

Email of Additional Contact

Enter Email Confirm Email

Please click on the Submit button below to finish

Thank you for submitting to speak at the ENTELEC Fall Seminar. The Technical Committee will be reviewing all submissions and you will be notified later if this panel (or your panel participation) was accepted to be part of the educational line up.

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Panel Discussion Form

If you are completing this form for someone else, please complete the information below.

Please click on the Submit button below to finish

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