Speaker Registration Form

Speaker’s Contacts
Name (in English)*
First Last
Name (in Russian)
First Last
Job title (in English)*
Job title (in Russian)
Company (in English)*
Company (in Russian)
Speaker’s biography (in English)*
Up to 150 words
Speaker’s biography (in Russian)
Up to 150 words
Speaker’s recent photo*
Accepted file types: pdf, jpg, jpeg, png.
Please attach or email ru@minexforum.com speaker’s recent colour photo in high resolution (max file size 5 MB).
Email*
Landline
Mobile
Social Networks
LinkedIn
Facebook
Twitter
Speaker's Assistant's Contacts
Assistant’s full name
Assistant’s email
Assistant’s phone
Presentation Details
Presentation title (in English)*
Presentation title (in Russian)
Short synopsis ~150 words (in English)*
Short synopsis ~150 words (in Russian)
Time required*
Select time required
Preferred language*
Select presentation language
Finish and Pay
The following information is required for use by Advantix Ltd for invoice and in the event of any queries.
Total
$0.00
Select Payment Method*
- Credit Card (Sripe)
- Credit Card (PayPal)
- Bank Transfer
Credit Card

American Express
Discover
MasterCard
Visa
Card Number Expiration Date Security Code Cardholder Name

Your Comments
*
- I have read and agreed to participation terms and conditions.
Terms & Conditions
Newsletter
- I agree to receive newsletters and special offer notices from MINEX Forum events
Phone
This field is for validation purposes and should be left unchanged.

Presentation Proposed For: