2013 Conference Speaker Agreement Form

Please fill in all areas below. Deadline: May 9, 2014

I have read the entire speaker manual and filled out all information requested above.

I understand that deadlines are extremely important and agree to meet all of them. I also agree that it is my responsibility to meet these deadlines without multiple reminders.

I will work with my Liaison/Presentation Review Team, as necessary, to ensure the best presentation possible.

During my presentation, I will not promote my services or my company. I agree to present the session as it was agreed with the Speaker Team in my 200-word description

I will notify QRCA immediately in the event that an emergency would prevent me from meeting my obligation as a conference speaker. *

By signing, I hereby understand and agree that if I do not complete and submit materials on or before set deadlines that my information will not be included in conference materials.

I warrant and represent that, to the best of my knowledge, nothing in my presentation violates any proprietary or personal rights of others (including, without limitation, any copyright or privacy rights) is factually accurate, and contains nothing libelous or otherwise unlawful. *

I warrant and represent that my presentation is my own original work, that I have the authority to enter into this Agreement, and that I am the sole copyright holder or that I have obtained all necessary permissions or licenses from any persons or organizations whose material is included or used in my presentation.

I understand that an agreement to speak at the QRCA conference equates to agreement for QRCA to
1) use my name and/or image in photos, video, internet transmission or other media,
2) create and use conference speaker ‘teaser or promotional interviews’ for publicity of sessions (audio and/or video),
3) use recorded on-site session for Qcasts or Chapter meetings,
4) record my presentation and sell the audio recording to QRCA members,
5) video record my session for posting on the QRCA website for access by members only.

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