Speaker Information Form

* Asterisks indicate fields that MUST be completed

Professional Title (if appropriate)

First Name(s) *

Surname *

The answers above will determine the way in which your name is listed on the programme.

To standardise the format in which names appear on our programme, we include civil honours (e.g. OBE, AM etc.), military honours (e.g.VC), or state appointments (e.g. MP, QC etc.) after surnames. We will not be including post-nominals relating to membership of professional bodies or academic degrees (e.g. MSc); all these can be referenced in bios below and speakers with a PhD may select the professional title Dr. from the drop-down list.

Job Title (to be displayed on the conference programme) *

Company/Organisation Name (to be displayed on the conference programme) *

Cell/Mobile Phone Number (inc. country code) *

Country of Permanent Residence *

Please upload a high resolution headshot of yourself HERE.

Click or drag a file to this area to upload.

Choose File

Please upload a high resolution logo of your organisation here (if appropriate)

Click or drag a file to this area to upload.

Choose File

Bio: Maximum 150 words *

Presentation Title (if known/relevant) *

Are you willing for us to share your presentation (in PDF format, without videos) on a secure password-protected area of our website, with delegates after the conference? *

We are running an extensive event marketing campaign. We hope that you are agreeable to being referenced within it. In respect of this, please could you advise us of:

- Your LinkedIn profile (if any)

- Instagram account (if any/appropriate)

- Other personal professional online listing

- Any other social media profile for your organisation, project or employer (if appropriate)

Which professional associations (related to your work or your proposed presentation) are you a member of?

Does your organisation have any newsletter (or other marketing channel) that might be able to share the news of your speaking at Behavioural Analysis 2026?

Would you like us to issue you with a 20% discount code that you could share with your colleagues and contacts?

Speakers are entitled to invite ONE colleague at 50% off the prevailing rate. Please enter the name, job title, organisation and email of the guest you wish to extend this offer to. By completing this box, you are giving us permission to write to the person with the offer.

Would you be willing to record a very short (max. 45 second) video inviting people to attend Behavioural Analysis 2026 and telling them what you will be talking about? If YES, you can either record it yourself and email it to gchahal@behaviouralanalysis.com or we can arrange to record it over a Zoom call. The video will be used to cross-promote your involvement with the conference as a speaker and the conference itself. * *

Green Light cordially invites speakers and moderators (only) to an informal cheese and wine welcome reception on the evening before the conference commences. In principle, would you be able to attend a reception at 6:30pm on Tuesday 15th September?

After the conference proceedings end on 18 September, we are organising an optional tour of Auschwitz-Birkenau Memorial and Museum for all attendees. Plans will not be finalised until July 2026 (due to limitations on advanced booking from the museum).

In principle would you like to join the tour. We anticipate the coach will leave the Qubus Hotel at 1315 and return around 2000. *

Do you agree with the Behavioural Analysis 2026: Attendee Code of Ethics

Yes

Thank you for your submission.

There was an error trying to submit your form. Please try again later or email gchahal@behaviouralanalysis.com