2015 Conference Speaker Agreement Form

Please fill in all areas below. Deadline: May 29, 2015

I have read the entire 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) record the audio of my presentation and offer it to conference attendees as a supplement to the PowerPoint deck,

I agree that if my presentation includes any personally identifiable data/information in any form (written, audio, visual, video, or other) that could cause a research participant or bystander to be identified, I will do one or both of the following:

A) Before submitting my presentation, I will obtain informed consent, in written or recorded form, from that person (or if a minor, their parent), to use that material for presentation during this conference and in any material distributed where that material appears. (Please note that general research participation agreements such as “material captured during this research will be used for market research purposes only” are not considered “informed consent.”)

B) Before submitting my presentation, I will “de-identify” (make anonymous) any personal data/information in any form (written, audio, visual, video, or other) that could potentially cause a research participant or bystander to be identified. I understand that this may require eliminating, masking, blurring, pixelating, distorting, cropping, or modifying the data in other ways.

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