2013 RUSA SPEAKER WAIVER FORM

 
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1. Your Name:
2. Your Title and Affiliation
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3. E-mail Address:
4. Member ID (if ALA member):
5. Phone:
6. Mailing Address:
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7. Title of Program/Preconference/Discussion Forum (official RUSA title)
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8. 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.
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9. HANDOUTS: PRODUCTION AND DELIVERY (Check One)

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10. INTERNET WAIVER AND AUTHORIZATION (Check One)

By submitting this form, I do hereby authorize the Reference and User Services Association, a division of the American Library Association, to make available on the RUSA Web site and/or ALA Connect the handouts and/or presentation I provide for the above-named session. I will work with the chair 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.

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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 RUSA 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 RUSA, may use and/or reproduce such photographs and recordings.

I hereby release RUSA 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.

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

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13. Date:
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