Annual Meeting Speaker Form

Thank you for agreeing to present at the EBAA Annual Meeting.

"*" indicates required fields

Speaker Information

Name

First Last

Designation (CEBT, MD, PhD, etc)

Cell Phone

Organization/ Institution/ Company

Job Title

Address

Enter your mailing address below.

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Brief Bio

Brief Bio: Your bio should be 2-3 sentences in the third person, highlighting your present professional responsibilities, previous experience relevant to the topic of your presentation, and educational background.

Headshot

Headshot- Please upload a photo of yourself to be used in meeting materials.

Drop files here or

Accepted file types: jpg, gif, png, Max. file size: 25 MB.

Presentation Information

Presentation Title

Presentation Summary

Presentation Description: Ensure your session title and description match the intended content and outcomes.

Speaker Agreement

Speaker agreements*

As a speaker for the Annual Meeting, I agree to and grant EBAA the following:

I will submit my presentation to the EBAA office by the due date.

A non-exclusive, world-wide, royalty-free license to record, broadcast, and sell or offer as complimentary your Presentation by conference call, webinar, and/or online broadcast, with accompanying outlines, PowerPoint presentations, documents, and/or handouts (hereinafter, “Materials”) provided by me.

The right to edit, transcribe, duplicate, distribute and sell or offer as complimentary, at EBAA’s discretion, recordings and copies of my Presentation and Materials, in whole or in part, on EBAA’s eyeLEARN website eyelearn.restoresight.org or the EBAA website restoresight.org, or in any and all media now existing or hereafter developed by EBAA throughout the world.

The right to use Presenter’s name and voice, Presentation title, Presentation description and biographical information in publicity, promotion and advertising in connection with the Presentation and the Materials.

The right to post the presentation in the meeting materials, including the event meeting app..

I will only include material and content that I have obtained permission to use and will cite material from outside sources.

Speaker Information

Presentation Information

Speaker Agreement

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