Speaker Name:(Required) First Last Speaker Title / Position:(Required) Speaker Company/Organization:(Required) Speaker Email:(Required) Speaker Phone:(Required)Business Address:(Required) 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 ROSA ENERGY CONFERENCE SPEAKER INFORMATION:(Required) I have reviewed the following speaker information for the ROSA ENERGY CONFERENCE, March 24-25, 2025 in Tulsa, OK stated below:We are honored you have agreed to be a speaker at the ROSA ENERGY CONFERENCE, March 24-25, 2025 in Tulsa, OK. Your expertise, experiences and insights will enhance the value of those attending. This is going to be a transformative conference, and we encourage you to attend the full conference (both days) to continue the conversation with the other participants. Conference registration fee is WAIVED for all of our presenters because of our corporate sponsorships. Please consider supporting the conference even more by being a corporate sponsor of this high-level gathering so we can expand our reach. A link to Corporate Sponsorship levels is found on the conference homepage. Presenters: Power Point Presentations are welcomed, but not necessary. If you want to just talk to the audience that is fine. Please let us know what you prefer on this form and we will follow up with you regarding the specifics of your talk. Panelists: Details about how the panels will be formatted is forthcoming. Your help in PROMOTING this conference would be greatly appreciated. Please post on LinkedIn and send information to your colleagues, customers/clients and association members. A note from you encouraging them to sign up will help boost attendance in this conference. Beginning and ending with conversations, we look forward to welcoming you to the ROSA ENERGY CONFERENCE on the beautiful University of Tulsa Campus. PRESENTATION FORMAT (check one):(Required) I plan to have a Power Point Presentation I do not plan to use Power Point TBD NETWORKING MIXER & DINNER | Monday, March 24 | 5:30 pm | SUMMIT CLUB in Downtown Tulsa (ticketed event - check one):(Required) $125.00 | Reserve a place for me at the dinner $125.00 | Reserve a place for my guest at the dinner I am unable to attend REGISTRATION SUBMITTALComplete this registration form, then click the SUBMIT button below. Once your registration is received in our office, we will contact you via email with additional information about the conference. NOTE: If you signed up for the Monday night dinner, you will receive instructions on how to make a cc payment using the university's secure online payment portal. NOTE: payment is due immediately after receiving this email to secure your spot at the dinner.Let us know if you have any QUESTIONS or COMMENTS: CONTACT US:ROSA ENERGY CONFERENCE The University of Tulsa Continuing Education for Science & Engineering 918-631-3019 | cese@utulsa.edu | www.cese.utulsa.edu 800 S. Tucker Drive, Tulsa, OK 74104