ANNUAL CONFERENCE SPEAKER WAIVER FORM

Midwinter Conference Year:

Annual Conference Year:

Your Name:

E-mail Address:

Title of Program/Preconference:

Date of Program/Preconference:

Please complete each section of this form as outlined below. Return the completed form electronically to your program planner no later than December 1, 2010, or mail directly to the RUSA office: Liz Markel, RUSA Marketing Specialist, 50 E. Huron St., Chicago, IL, 60611—For the Annual conference, please put AC20XX Speaker Waiver (e.g. AC2011 Speaker Waiver) on the envelope and for the Midwinter conference, please put MW20XX (e.g. MW2011 Speaker Waiver) on the envelope so that it may be easily identified. Forms may be faxed to the ALA office with a cover sheet to the attention of Liz Markel, RUSA, at 312-280-5273. Please let your program planner know how and to whom you are delivering the completed form.

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.

HANDOUTS: PRODUCTION AND DELIVERY

___ I would like RUSA 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 Monday, May 2.

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

___ I will not have any handouts.

INTERNET WAIVER AND AUTHORIZATION

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 the handouts and/or presentation I provide for the above-named session. I will send an electronic copy of my handouts and/or presentation to the chair of the program committee. (The program chair will make the final decision on the posting of handouts and/or presentations to the RUSA Web site.)

___ I want my handouts and/or presentation made available on the RUSA Website.

___ I do not want my handouts and/or presentation made available on the RUSA Website.

PHOTOGRAPHY, VIDEO AND AUDIO RECORDING

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.

___ 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.

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Print Name

Signature

Date

RUSA Speaker Waiver Form Page 2 of 2