SPEAKER’S PERMISSIONS FORM

For good and valuable consideration, receipt of which I acknowledge, I hereby irrevocably grant to Yale University (“Yale”), its assigns, licensees and successors the nonexclusive right to photograph, publish, record, broadcast, exhibit, digitize, display, copyright, license, transfer, reproduce, translate, modify, edit or otherwise use perpetually throughout the world, in all media now and hereafter known or devised, in whole or in part, my image, likeness, name, biographical information, actions, performance, voice, conversations and material spoken or otherwise provided by me to Yale in connection with the lecture(s), interview(s), and/or speech(es) delivered by me on ______, 2014 (collectively, the “Material”), for educational, promotional, and any other purposes that support Yale’s mission. Yale acknowledges that it will make reasonable efforts to provide attribution to the author/creator when disseminating whole or part of a lecture, speech, discussion, presentation or other public appearance.

I represent and warrant that: (i) I have the authority to grant the rights granted under this Speaker’s Permission Form; (ii) except as to items identified on the Third-Party Material Disclosure Form attached to this Speaker’s Permission Form (“Disclosed Third-Party Material”), I am the owner of all proprietary rights, including any copyrights in the Material and the Material has not been and will not be copied in whole or in part from any other work; (iii) I have obtained all required permission or copyright clearances necessary for Yale’s use of any Disclosed Third-Party Material, and (iv) neither the Material nor its use as contemplated under this Speaker’s Permission Form will infringe upon or violate any rights of any third party.

I hereby release Yale University, its officers, trustees, employees, agents, licensees, successors and assigns, from any and all liability for damages for libel, slander, invasion of privacy, copyright infringement or any other claims based on the publication, exhibition, display, copyright, license, transfer, reproduction, editing, disposition or other use of the Materials.

I understand that Yale is not obligated to use the rights granted to it under this Speaker’s Permission Form.

This Speaker’s Permission Form shall be governed by the laws of the State of Connecticut without regard to its principles of conflicts of laws, and shall be binding on me, my heirs, assigns, licensees, and legal representatives.

Disclosure form attached? Yes □ No□

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