Speaker RequestRequest form for speakers at the Pacific ICT Ministers’ Dialogue. Speaker Request Form Please enable JavaScript in your browser to complete this form.A. Country/OrganizationName of Country/Organization *Select Country/OrganizationPapua New GuineaAustraliaCook IslandsFederated States of MicronesiaFijiFrench PolynesiaKingdom of TongaKiribatiMarshall IslandsNauruNew CaledoniaNew ZealandNiuePalauSamoaSolomon IslandsTokelauTuvaluVanuatuAPTITUPIFPITASPCGFCEOtherSelect your respective country or organization.Other: Please specify organizationB. Speaker DetailsTitle *Hon.Sir.MadamDr.Mr.Mrs.Ms.OtherOther: Specify TitleName *FirstMiddleLastField #41 (copy)Position/DesignationDepartmentMinistry/OrganizationSpeaker ID Photo * Click or drag a file to this area to upload. The photo should be a high-resolution head and shoulders only, taken ‘Full Face’ without hat or tinted glasses and with a light-colored background. File type must be .jpg, .png, .doc, .pdf and less than 10MB.Email 1 *EmailConfirm EmailEmail 2EmailConfirm EmailC. Presentation DetailsTitle of Statement or PresentationLayoutShort quotation for Social Media (for media pursposes)Upload File Click or drag a file to this area to upload. Upload a copy of the Statement or Presentation. Allowed document file formats/extensions are .pdf, .docx, .pptxBio DataSubmit
