2022 Regenerate Special Events Presenter Intake Form Which event are you speaking at? (you can put the name of the event, the location or the name of the farm/ranch owners)* Speaker InformationItems marked with a + will be included on the conference website and in the program.Name +* First Last Pronouns (optional) Email* Please enter the primary email address we should use to communicate with you regarding your presentation, registration, and other logistics.Email +* Please enter the email address that you would like to have listed in the conference program. Please notify us at [email protected] if you don't want your email listed in the program.Phone*There may be times when we need to contact you by phone regarding logistics. Please enter the number you'd like us to use.Primary Title and Affiliation +* The primary title and affiliation you enter here will be included on the conference website and virtual platform, and in the program. You have the option to submit a secondary title and affiliation below. If space allows, we may list the second title and affiliation, as well.Secondary Title and Affiliation If you'd like to submit a secondary title and affiliation, please complete this section. If space allows, we may also list the second title and affiliation on the conference website and in the program.City and State +* City State / Province / Region 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 Country Photo(s) +* Drop files here or Select files Accepted file types: jpg, jpeg, tif, png, gif, Max. file size: 15 MB, Max. files: 4. Please upload a headshot and/or photo(s) of yourself doing the work you love! You can upload up to four photos in the following formats: JPG, JPEG, TIF, PNG, and GIF. The maximum file size allowed for each photo is 15MB.Personal Bio +*150 word limit, please prepare in 3rd person. Please note that we will copyedit and proofread your bio before posting it, but we will not alter its content.Website + Have you published books, papers, and/or articles that you'd like us to showcase online?* Yes No Please list the title(s) and/or URLs of your publications.*Social Media LinksPlease list links or handles to social media accounts that you would like to have associated with the REGENERATE Conference.Lunch will be provided. Do you have any dietary restrictions? Yes No If yes, what restrictions do you have?