Thank you for agreeing to present at the EBAA 2023 Annual Meeting. "*" indicates required fields Speaker InformationName First Last Designation (CEBT, MD, PhD, etc) Email Cell PhoneOrganization/ Institution/ Company Job Title AddressEnter your mailing address below. Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country CountryAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Brief BioBrief 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. HeadshotHeadshot- Please upload a photo of yourself to be used in meeting materials. Drop files here or Select files Accepted file types: jpg, gif, png, Max. file size: 25 MB. Presentation InformationPresentation Title Presentation SummaryPresentation Description: Ensure your session title and description match the intended content and outcomes.Speaker AgreementSpeaker 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.
