2023 IPLI Information Request

Name*

Position*

Company*

Email*

Phone*

Do you have any dietary restrictions or do you require any special accommodations? If so, please provide details.

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BIO AND PROFESSIONAL HEADSHOT

(Your bio and headshot will be published in the IPLI2023 booklet. Please proofread before submitting this form.)

Bio (max 1,000 characters)*

Professional Headshot (min 300 dpi, jpg/jpeg files only)*

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REQUIRED AGREEMENTS

HNBA/VIA IPLI2023 Individual Release

Indiv Release*

I confirm that I have read, understand, and agree to the above HNBA/VIA IPLI2023 Individual Release linked above.

Code of Conduct*

I confirm that I have read, understand, and agree to the above HNBA/VIA Code of Conduct linked above.

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