First Name
Last Name
Job Title
Company Name
Email
Phone
Company URL
Company Twitter
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What type of company are you? Insurer/Carrier Reinsurer Early Stage Investor Mid/Late Stage Investor Investment Bank/Other Financial Services Startup/Insuretech Accelerator/Innovation As A Service/Co-Creation Agency/Broker (Regional) Agency/Broker (National/International) Technology Solution Provider Claims Adjustor/TPA MGA/Digital MGA Specialty Network (e.g. Roadside/Repair Centers/Disaster Recovery/Etc.) Professional Services (Legal/Consulting/Aduiting/Etc.) Regulator/Government Press Other
Speaker Brief Bio and/or Areas of Expertise
Which Insurance Lines of Business apply to you? Commercial Lines – D&O Commercial Lines – Fleet Commercial Lines – Property Commercial Lines – Small Commercial Commercial Lines – Workers Comp Cyber Embedded Insurance Health / Wellness / Benefits Health / Wellness / Employee Benefits Life & Annuities Personal Lines – Auto Personal Lines – Home Personal Lines – Pet Personal Lines – Renters Specialty Lines – Crop/Agriculture Specialty Lines – E&S Specialty Lines – Marine/Aviation Supplemental Health/Voluntary Benefits N/A Other
Which of the following best describes your Areas of Interest and Expertise? AI/ML Augmented Reality/Virtual Reality Blockchain Claims Connected Insurance: IoT/Smart Home/Connected Self Core Insurance Solutions Customer Engagement Cyber Diversity & Inclusion Drones High Net Worth Marketing/Marketing Tech Nursing/Medical/Case Management Mobility/Autonomy Pharmacy Benefits Product Development (New Insurance Products) Regulation/Compliance/LegalTech Risk Management Sales/Distribution Robotic Process Automation Sales Enablement Satellite Imagery/Computer Vision Telematics Underwriting Other
What part of the Insurance Value Chain do you focus on and/or are you trying to change?
What differentiates you from others solving similar problems?
Where are you based and what part of the world do you offer your services?
What is one major thing you/your company would like to accomplish in the next 12 months?
What speaking formats are you comfortable with? PanelDemo StageCase study
Will you be timing a launch or major announcement at ITC 2022?
What's one thing we didn't ask that you think we should know about you?
Submitter First Name (if different from speaker)
Submitter Last Name (if different from speaker)
Submitter Company Name (if different from speaker)
Submitter Job Title (if different from speaker)
Submitter Email Address (if different from speaker)
Would you be interested in seeing our sponsorship prospectus? YesNo
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