Your details Your name or contact name Title/Position Your company or organisation Telephone number Email address Type of organisation Conference/speech details Title of conference Date of conference/speech Location (City, Country) Requirement Name of requested speaker Speech subject Speech title/content Length of speech Proposed topics If available, please email a draft agenda to [email protected] Audience (sector/level) Expected numbers of attendees How and where will the event be marketed? Has this event taken place before? If yes, please email the delegate list to [email protected] Have you approached anyone else in ESMA about this? If yes, please state who. Is there a fee to attend this event? If yes, please specify. Will media be present? If yes, please give an indication of which publications are expected to be represented. Any additional details Return address [email protected] Contact David Cliffe, Senior Communications Officer + 33 1 58 36 43 24 ESMA • CS 60747 – 103 rue de Grenelle • 75345 Paris Cedex 07 • France • Tel. +33 (0) 1 58 36 43 21 • www.esma.europa.eu Speaker Request Form