This form is to apply for a seat at one of two moderated dinner sessions on 20 September or 4 October 2023. Confirmations will be extended per individual on a first come, first served basis.

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First Name: *

Last Name: *

Name of your Company/Practice: *

Email address: *

Phone number: *

Choose your preferred date: *

• 20 September 2023, 17:00–21:00
• 4 October 2023, 17:00–21:00
• Either of the mentioned dates

About you: *

Website / URL:

Your Instagram, LinkedIn, Threads, and/or other social media channels:

Any dietary requests or necessities:

Submit