INSERT LOGO HERE CONFERENCE MEDIA RELEASE FORM (For participants appearing and speaking at CONFERENCE) Date: _____________________________ Name of panelist, interviewer or speaker: Print Name:______________________________________________ I understand that the _____________________ conference will be recorded and filmed. I hereby grant CONFERENCE ORGANIZATION the right to: Have use of photographs, podcast recordings or film/video recorded at the DATE AND CONFERENCE NAME All such photographs and/or recordings and all rights therein and thereto shall be the property of ORGANIZATION and may be used in a lawful manner. In granting these rights I understand that I hereby release ORGANIZATION and its employees from all actions, causes of actions, claims and demands except for those arising from the negligence of ORGANIZATION. Signed:_________________________________Date:_______________________