2012 Asian Confederation of Institute of Internal Auditors Conference

Speaker Nomination Form

Please use this form to nominate individuals whom you know to be knowledgeable, skilled and entertaining public speakers to be considered for engagement by the 2012ACIIA Conference Programme Committee. The programme is targeted to encompass at least 5 tracks and cover a range of issues of current interest to internal audit professionals worldwide.

The theme for the 2012 IIA International Conference Theme “Sala-Thai” aptly fits the chosen logo of the Sala-Thaiwhichsimply reflects “the perfect organization under well internal auditing performance and sharp management.”

After full consideration, the Programme Committee will extend invitations to those world-class speakers who are deemed to best represent the 2012ACIIA Conference. Please fill in all required information as it will greatly assist the Programme Committee in the evaluation exercise.

NOMINEE NAME and CONTACT INFORMATION
First Name
Last Name
Title
Organisation
Address 1
Address 2
City / State or Country / Zip or Postal Code
Telephone / Fax
Email
Compensation Requirement
(if any)
SPEAKER PROFILE
Please enter a brief description of your qualifications and speaking experience
(200- 300 words only)

Please indicate by checking (√) the 2012 ACIIA Conference Concurrent Sessions track for which the nominated speaker might be best suited:

Fraud Detection & Prevention
Information Technology
Corporate Governance & GRC
EnterpriseRisk Management
IA Skills & Capabilities
POSSIBLE / PREFERRED TOPIC #1
Title :
4 -5 presentation points

POSSIBLE / PREFERRED TOPIC #2
Title :
4 -5 presentation points

Please return the completed Speaker Nomination Form to the 2012 ACIIA Conference Programme Committee by email (as an MS word or Adobe Acrobat PDF attachment), fax or mail as follows:

Organization Committee Chairman, 2012 ACIIA Conference, Bangkok, Thailand.

Email:

Fax: +66 2 712 9124-7 Ext. 108

Mail: 2 St’Gabriel Foundation Building, Soi Thonglor 25, Sukhumvit 55 Rd., Khet Wattana, Bangkok 10110,

Thailand

Submission Date By: 15 March 2012