Conference Session Recording Release Form
Please complete this form to grant permission for the recording and use of your conference session participation.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Organization / Affiliation
Session Title
*
Session Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Role in Session
*
Please Select
Speaker
Panelist
Moderator
Attendee
Other
Type of Recording (select all that apply)
*
Video
Audio
Photographs
Screenshots
Other
Intended Use of Recording
*
Live streaming during the event
On-demand viewing after the event
Promotional materials
Educational content
Other
Please specify any restrictions or special instructions regarding the recording or its use
Signature
*
Submit Release Form
Submit Release Form
Should be Empty: