Speaker Agreement and Release Form
Complete the information below and fax it to Madeleine Saikaley by September 29th, 2008
Fax: 613-736-9852 or email your request to firstname.lastname@example.org
This Agreement and Release is made by:
Full Name: ____________________________________________________________________
Company: __________________________________Phone: _____________________
Fax: ________________________________Email: ____________________________________
City: ___________________Province: _______________ Postal Code: ________________
The Event is: The GTEC 2008 Conference
I ACCEPT THE OFFER OF UNITED BUSINESS MEDIA TO PARTICIPATE AS A SPEAKER AT THE
EVENT. I UNDERSTAND AND AGREE THAT:
• By participating as a Speaker at the Event, I consent to the terms and conditions of this Agreement
and Release, even if I have not executed this form and returned it to United Business Media as
• I will not be paid for my services as Speaker, nor will my expenses be reimbursed, unless I have a
separate fully executed compensation agreement with United Business Media regarding the Event.
No fees will be paid on account of any reproduction or distribution of any materials that include any
aspect of my participation in the Event.
• I will fulfill the Speaker obligations described in the Speaker Guidelines for the Event, including but
not limited to deadlines for producing materials and other requirements.
• The Event is an educational event, not a sales or marketing platform. United Business Media is
retaining me to provide an objective presentation that meets the educational needs of the Event
• United Business Media may record, in any format, my presentation at the GTEC 2008 Conference.
For consideration, hereby acknowledged to be received, on my own behalf and on behalf of my
employer, I grant to United Business Media and its designees, the irrevocable right to record,
transcribe, reproduce, display and distribute, in whole or in part, my presentation on or over the
GTEC Conference web site for a period of one year from the date of my presentation, and I
consent to the use of any text, other image, or sound in conjunction with my presentation. Any
such reproduction, display or distribution of my presentation on the GTEC web site will be in good
taste, and in compliance with all relevant laws. I waive and release United Business Media from all
claims arising out of such use of my presentation made in accordance with this Release.
I am over 18 years of age and have the right to contract in my own name, and to make the above
commitments on my own behalf and on behalf of my employer. I understand that this Release binds me and
my employer, and our respective legal representatives, assigns, and heirs.
I have read and understood this Speaker Agreement and Release.
Date & Signature: ____________________________________________________________