Speaker Submission Form

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Thank you for agreeing to present a webinar! Please complete the form below to confirm your agreement as a presenter, and to help us effectively market your session.

I have read the Privacy Policy and grant consent to use my data.

Full name and title *
Preferred Name
Pronouns
Email Address *
Speaker Headshot (JPG or PNG, minimum size 300x300 pixels) *
Speaker Bio (up to 200 words) *
(Maximum characters: 1500)
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Session Information

Confirm the details of your session

Event Title *
Event Date *
Event Time (Eastern Time) *

Marketing information

To help us promote your webinar, please provide the following information.

Session Description/Summary
(Maximum characters: 2000)
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Key Takeaways/Learning Objectives: What will attendees get out of your session?
(Maximum characters: 2000)
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I agree to the following with respect to the above listed program:

AGREEMENTS:

  • Responsibilities. I agree to present my Program on the date and time identified above, as it was laid out in my presentation description.
    • I agree to meet all deadlines and understand that missing deadlines could impact the inclusion of my Program within program materials.
    • I will notify SVIN immediately in the event that an emergency would prevent me from meeting my obligation as a program speaker.
    • I understand that my presentation is not a showcase for the promotion of my business, practice, or product. As SVIN programs are noncommercial forums, the direct promotion of products and services is prohibited.
  • Rights. I hereby provide SVIN consent to display and provide the above- recorded Program and related presentation materials via the SVIN website, including:
    • The video and audio recording of my Program,
    • The use of my name and/or image in photos, video, internet transmission or other media in connection with promoting the Program,
    • The right to charge for access to this recorded Program. Other than the rights granted to SVIN as set forth above, Speaker owns the rights to the work and is free to use the work in Speaker’s professional capacity or employment.
  • Representations and Indemnification. I warrant and represent that my Program (materials and session) is my own original work, factually accurate, and contains nothing libelous or otherwise unlawful. This includes:
    • I am the sole owner of every aspect of my presentation.
    • I have the authority to enter into this Agreement, including the legal right to grant SVIN permission to use my Program in the manner contemplated by this agreement.
    • I have obtained all necessary permissions and licenses to use all of the material in my presentation, including, but not limited to, pictures, clip art, songs, sounds, video and written/printed content.
    • Before submitting my presentation, I will de-identify (remove) personal data/information/images in any form (written, audio, visual, video, or other) that could identify a person who has not explicitly consented to that person’s personal data/information/image being included in my presentation. I understand that this may require deleting, masking, blurring, pixelating, distorting, cropping, or modifying the data in other ways.
    • I agree to indemnify, hold harmless, and defend SVIN from and against any losses, liabilities, damages, costs and expenses, including reasonable attorneys’ fees and all other costs of defense, arising out of any third-party claim or threatened claim against SVIN arising out of any breach of the representations or warranties made by me in this Agreement.
  • Any provision of this agreement which is prohibited or unenforceable shall be ineffective only to the extent of such prohibition or unenforceability without invalidating the remaining provisions of this agreement.

Printed Signature *
Date of Signature *



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