Speaker Consent Form

"*" indicates required fields

Name*

First Last

Company*

Job Title*

Email Address*

Phone*

Personal LinkedIn Page

Personal X (Twitter) Handle

Date of Event

Please enter your short bio*

Please attach your headshot*

Max. file size: 50 MB.

Please attach a high resolution, transparent version of your company logo*

Max. file size: 50 MB.

Marketing/Communications Representative Name*

First Last

Marketing/Communications Representative Email*

Company Twitter Handle

Company LinkedIn Page

Media Coverage:

The event will be open to the media. Please note your willingness to participate in media outreach before, during and after the event:

Are you willing to participate in a phone interview with non-local reporters before/after the event?

Are you available/interested in talking to media on-site during the event?

NVTC records its events as a member resource. The video recording may be published on the NVTC website and promoted through NVTC communications channels. By speaking at the event, you acknowledge that the information you are presenting is not confidential and can be shared.

If you have any questions, please contact Tarin Horan, VP of Events and Sponsorships | thoran@nvtc.org

* By clicking submit I hereby consent to and authorize the use and reproduction in print or electronic format, by NVTC or its authorized agents, of any and all photographs, audio or video which may be taken of me and/or my company at this event, for any publicity purpose, without compensation. I acknowledge and agree that all images, whether electronic, negatives and positives or otherwise, together with the prints, are owned by NVTC. I hereby acknowledge that I am 18 years of age or older and have read and understood the terms of this authorization and release.