Personal Information - CX / Services Leadership Summit

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Personal Information

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* First name:

Preferred Name (if different; to be used on badge)

* Last name:

* Email address:

* Mobile:

*

Function/Department:

This question is required.

*

If other:

* Location:This question is required.

Please list any dietary restrictions and/or food allergies we should be aware of.

*

Preferred Shirt Style:

This question is required.

Men's / Unisex Cut
Women's Cut (more fitted than unisex)

*

Preferred Shirt Size:

This question is required.

XS
S
M
L
XL
XXL
XXXL

Travel Information

*

How will you be arriving to the summit?

This question is required.

Flying
Driving

*

Airline:

*

Flight Number:

*

Departure City

*

Name of Emergency Contact:

* Emergency Contact Phone Number (please include country code):

Your answer can only contain the following special characters:

Any letter

Any number

Spaces

@ : + \ , - . /

Setting the Stage

*

What strength do you want to be known for as a leader, and how are you using it today?

*

What's something that reminds you why your work matters?

*

What is (or would be) your go-to karaoke song?

See you in 16 days 17 hours 42 minutes

16
Days
17
Hours
42
Minutes
29
Seconds