Conference Speaker Interaction Consent Form
Please complete this form to provide your consent for interactions, recordings, and participation as a speaker at the conference.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Session Title
*
Consent to be Recorded (audio and video) during your session
*
I consent
I do not consent
Consent for Photography during your session
*
I consent
I do not consent
Permission to Publish Session Materials (slides, handouts) on conference platforms
*
I grant permission
I do not grant permission
Permission to Participate in Q&A and Audience Interaction
*
I agree
I do not agree
General Release: I acknowledge and agree that my participation may be used for conference promotion and documentation.
*
I acknowledge and agree
Speaker Signature
*
Submit Consent
Submit Consent
Should be Empty: