Speaker Form

Thank you for lending your expertise to EBAA and for agreeing to present to the membership. As we prepare for your presentation, please submit the required information and materials using the form below to confirm your participation. We look forward to your presentation!

"*" indicates required fields

Name

This field is for validation purposes and should be left unchanged.

Name*

First Last Designation

Email*

Phone Number

Please enter a phone number at which you can be reached during the webinar in case of technical difficulties.

Organization/Eye Bank*

Job Title*

Brief Bio*

Enter a brief bio to be used in promotional material and during the webinar introduction.

Headshot*

Please upload a photo of yourself.

Drop files here or

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

Speaker Agreement

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

A nonexclusive, 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.restoresightorg 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.

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

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