2013 ASCLA SPEAKER WAIVER FORM
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1. Your Name:

Your Name:

2. Your Title and Affiliation

Your Title and Affiliation

3. E-mail Address:

E-mail Address:

4. Member ID (if ALA member):

Member ID (if ALA member):

5. Phone:

Phone:

6. Mailing Address:

Mailing Address:

7. Title of Program/Preconference/Discussion Forum (official ASCLA title)

Title of Program/Preconference/Discussion Forum (official ASCLA title)

8. Date and Time of Program/Preconference/Discussion Forum (e.g. Friday, 9a-5p or Sunday, 4-5:30p.m.)

Date and Time of Program/Preconference/Discussion Forum (e.g. Friday, 9a-5p or Sunday, 4-5:30p.m.)

COPYRIGHT PERMISSION

By signing at the bottom and submitting this form, I warrant that all of the material that I provide for program handouts is my own original work; that it does not violate any copyright or other proprietary rights of others; that it is factually accurate and contains no libelous matter; and that I assign ALA the copyright therein for purposes of distributing the handouts and posting them on the Internet (if approved below). This copyright assignment will specifically not prevent you from presenting or publishing the same material or using portions thereof as you choose.

Please complete each section of this form as outlined below no later than February 15, 2013.

9. HANDOUTS: PRODUCTION AND DELIVERY (Check One)

HANDOUTS: PRODUCTION AND DELIVERY (Check One) A. I would like ASCLA to assume responsibility for duplication of the program handouts and their delivery to the conference. I agree to e-mail an electronic copy of the handouts to the chair of the program committee by May 1, 2013.

B. I will be responsible for handout duplication and will bring them to the program.

C. I will not have any handouts.

10. INTERNET WAIVER AND AUTHORIZATION (Check One)

By submitting this form, I do hereby authorize the Association of Specialized and Cooperative Library Agencies, a division of the American Library Association, to make available on the ASCLA Web site and/or ALA Connect the handouts and/or presentation I provide for the above-named session. I will work with the member program planner to post my documents in ALA Connect as attachments to the program listing in the conference planner, and also provide an electronic version to the program planner.

INTERNET WAIVER AND AUTHORIZATION (Check One) By submitting this form, I do hereby authorize the Association of Specialized and Cooperative Library Agencies, a division of the American Library Association, to make available on the ASCLA Web site and/or ALA Connect the handouts and/or presentation I provide for the above-named session. I will work with the member program planner to post my documents in ALA Connect as attachments to the program listing in the conference planner, and also provide an electronic version to the program planner. I want my handouts and/or presentation made available online.

I do NOT want my handouts and/or presentation made available online.

11. PHOTOGRAPHY, VIDEO AND AUDIO RECORDING (Check One)

I hereby consent to the photographing and recording of myself, and the use of these photographs and/or recordings singularly or in conjunction with other photographs and/or recordings for advertising, publicity, commercial or other business and/or educational purposes. I understand that the term “photograph” as used herein encompasses both still photographs and motion picture footage.

I further consent to the reproduction and/or authorization by ASCLA to reproduce and use said photographs and recordings of my voice for use in all domestic and foreign markets. Further, I understand that others, with the consent of ASCLA, may use and/or reproduce such photographs and recordings.

I hereby release ASCLA and any of its associated or affiliated companies, their directors, officers, agents, employees and customers and appointed advertising agencies, their directors, officers, agents and employees from all claims of every kind on account of such use.

PHOTOGRAPHY, VIDEO AND AUDIO RECORDING (Check One) I hereby consent to the photographing and recording of myself, and the use of these photographs and/or recordings singularly or in conjunction with other photographs and/or recordings for advertising, publicity, commercial or other business and/or educational purposes. I understand that the term “photograph” as used herein encompasses both still photographs and motion picture footage. I further consent to the reproduction and/or authorization by ASCLA to reproduce and use said photographs and recordings of my voice for use in all domestic and foreign markets. Further, I understand that others, with the consent of ASCLA, may use and/or reproduce such photographs and recordings. I hereby release ASCLA and any of its associated or affiliated companies, their directors, officers, agents, employees and customers and appointed advertising agencies, their directors, officers, agents and employees from all claims of every kind on account of such use. I consent to the recording of my presentation as outlined above, and in so doing agree to all of the terms laid out in the preceding three paragraphs.

I do NOT consent to the recording of my presentation.

12. Print Name: By entering my name in this text box, I am signing this completed waiver form:

Print Name: By entering my name in this text box, I am signing this completed waiver form:

13. Date:

Date:

2013 ASCLA SPEAKER WAIVER FORMExit this survey

2013 ASCLA SPEAKER WAIVER FORM
Exit this survey