"UNIVERSAL VISIONARY HERITAGE"

In the
UNESCO World Heritage Middle Rhine
("Loreley Valley")

"Review the lost knowledge of the past with creative views for the present & the future!"

[Visiondium Inputs & Uploads]

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These products with texts, attributes or labels are trademarks ( ™ ) of Cosmoscopia Club International (CCI) and its partners which may contain confidential and / or privileged information. You can send us inputs or suggests for evaluation. If you find the data incorrectly or in error, please notify us directly. The unauthorized copying, and unauthorized disclosure of such data and their content are not permitted.

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DROPBOX

Conference Special Booking Form
[Visiondium (Vision Compendium)]

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Visiondium Presentation Form

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1. Presenter Details:

Name:

Full Address:

Country:

ZIP Code:

Email:

Phone:

Age:

Sex:

Male

Female

Language:

English

Non English

Please attach a head shot photo and if possible, your company logo, for use on the event web site when returning this form:
Upload a photo:
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Our Conferences will prepare press releases and other marketing materials related to this event. If you prefer not to be mentioned, please check this box:

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Please provide a brief resume / biodata / CV in paragraph format below (maximum 150 words):

2. Presentation Details:

Presentation Title:

Sub-topics: Please provide between 3-5 bullet points outlining the main points/ issues/ "take-aways" you will cover during your presentation:

Abstract/Summary: Please provide an abstract or summary of your presentation:

Keywords/Tags (such as Phenomenology, Metascience, etc. ):

3. Final Few Questions:

Yes

Please let us know if you would be happy to take part in/lead any interactive sessions such as roundtable discussions, meet the experts etc.:
Yes No

Would you be prepared to take part in a short pre-conference interview (by e-mail or telephone) with a member of the Cosmoscopia Club International (CCI) production team (to be used for pre-event PR):
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Have you produced any articles, white papers or similar that you would like to share via our event web site, and promoted though our marketing efforts?
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If yes, please attach them here.

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Do you have any colleagues that might be interested in receiving information about this event? If so, could you please enter their details below so we can send a copy of the brochure once it is launched:

Your recommendation:

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