Speaker Intake Form Name(Required) First Last Email Address(Required) Phone(Required)Please provide a number we can use to reach you the day of the event if needed. Position Title(Required)Company or Organization(Required)Please provide your affiliation:(Required) Wharton/Penn faculty member Faculty member from another school Industry practitioner Other Address(Required)If you are a non-Wharton/Penn affiliate, please provide your full contact information so that we may process your travel reimbursements. Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country LinkedIn Profile Do you have an administrative contact with whom we should coordinate?(Required) Yes No Name of Administrative Contact First Last Administrative Contact Email Address Please let us know if you have any dietary restrictions:Event Title(Required) Frontiers in Quantitative Finance Conference (Sep 26, NYC) Liquidity Conference (Oct 10-11, Wharton) FinTech Lecture Series (Multiple Dates, Wharton) Other Please upload a hi-res (300 dpi or higher) headshot:(Required)Max. file size: 100 MB.Please provide a short bio (text or link):(Required)September 25 Welcome Dinner RSVPFrontiers in Quantitative Finance speakers are invited to a Welcome Dinner on Thursday, September 25, along with members of the Jacobs Levy Center advisory board, prize winners, and other special guests. The dinner will be held in the Wilder Room on the 4th floor of the NY Marriott Marquis at 6:30 p.m.I will attend the welcome dinner:(Required)YesNoFrontiers in Quantitative Finance Conference Travel ArrangementsA block of rooms is available for speakers at the NY Marriott Marquis. Wharton can also reimburse additional travel expenses such as coach airfare, business or coach class rail, local transportation (taxis, ride shares, subway), and personal meals not included in the conference program, within current federal per diem rates (https://www.gsa.gov/travel/plan-book/per-diem-rates). Please note that we can generally not approve reimbursements for first or business class flights, flight upgrades, first class rail, and car/limo services. Reimbursements may be submitted after the conference. Please save itemized receipts to provide.Reserve a hotel room at the Marriott for me the nights of (check all that apply):(Required) Thursday, September 25 Friday, September 26 Other (please contact Jessica with details) Frontiers in Quantitative Finance Conference PresentationsWe ask that you arrive at least 30 minutes before your presentation to allow time for the AV team to mic you. Presentations will be displayed on 16:9 screens. Please submit slides to Jessica in PDF or PowerPoint format by Monday, September 22.I would like an AV check on the morning of Friday, September 26:(Required)YesNoWharton Media ReleasePlease let us know your preferences on recording and media for your presentation. This ensures proper marketing and media coverage is decided in advance of the event. Please complete both sections below. RECORDINGAs part of my appearance at the Wharton School, I give permission to record me, including images, audio, presentation and comments, with my name included, for use in electronic and print publications, and the School’s educational and engagement programs for potential and enrolled students, alumni and Friends of Wharton and Penn. The Wharton School may use these reproductions without further examination by me. I waive all personal claims, causes of action, liabilities, or damages against the School arising from or in connection with my performance or appearance.I have read the above release and:(Required) Agree Decline MEDIA COVERAGEThe Wharton School tends to allow media coverage of all public events. Media outlets include, but are not limited to internal independent media such as Knowledge@Wharton, Wharton Magazine, Wharton Journal, Daily Pennsylvanian and external independent media both local Philadelphia and beyond. The Wharton Media Relations Office is the direct liaison with the speaker/speaker’s office to ensure the maximum level of comfort with any public coverage of the event. Please complete both sections of the below form, including your event contact's name and email address so we can properly direct your submission to the appropriate group.I have read the above information and:(Required) Agree to allow INTERNAL Wharton media coverage of my comments and appearance at this event. Agree to allow EXTERNAL INDEPENDENT media coverage of my comments and appearance at this event. Decline to allow media coverage of my comments and appearance at this event. You may select multiple options.If you have any questions about this form, please contact Jessica Frankenfield (jfranken@wharton.upenn.edu), Associate Director of Events and Engagement, Finance Research Centers.