AHLA Speaker Release Form

---

AHLA SPEAKER RELEASE FORM

Please read, complete, sign, and return this form to American Health Lawyers Association, Attn: ________, 1620 Eye Street, NW, 6th Floor, Washington, D.C. 20006-4010 This Speaker Release shall serve as formal consent, permission, and authorization from the undersigned (“Speaker”) regarding the ___________________________ (the “Event”) occurring on ________________________ date. • Nonexclusive License. Speaker hereby grants AHLA a royalty-free nonexclusive license, on a commercial and noncommercial basis, to use, modify, publish, reproduce, prepare derivative works, distribute, publicly display, and archive any and all written, electronic, video, recorded, or graphical material that Speaker presents or submits in connection with the Event (collectively the “Presentation Materials”), in whole or in part, in all forms of media including but not limited to electronic rights. Speaker grants AHLA a right of first publication in the Presentation Materials, and therefore, Speaker cannot publish the Presentation Materials elsewhere until AHLA has published the Presentation Materials. • Speaker’s Rights. Speaker understands that he/she retains ownership of the Presentation Materials; however, Speaker further understands that AHLA shall retain all intellectual property rights in any resulting media that utilizes the Presentation Materials. Speaker also understands that this Speaker Release Form does not prohibit Speaker from using the Presentation Materials in the future in Speaker’s professional or personal work subject to AHLA’s right of first publication. • Creation and Use of Recordings. Speaker hereby grants permission to AHLA and its agents, including contractors, to photograph, videotape, audio record, and interview Speaker, and to use his/her image, name, and likeness (which may include biographical data) in any resulting photograph(s), video(s), podcasts, on-demand audio or video recordings, and/or recorded interview(s) (collectively, the “Recordings”), in whole or in part, in all forms of media including but not limited to electronic rights, marketing and promotional materials, and for-sale materials relating to the Event, AHLA, and AHLA's educational or membership programs. Speaker understands that AHLA shall retain all intellectual property rights in the Recordings or any resulting media utilizing the Recordings. • Representations and Warranties. Speaker represents and warrants that: (a) the Presentation Materials are original to the Speaker; (b) the Presentation Materials do not infringe any third party’s intellectual property rights and does not contain any material that is obscene, defamatory or libelous; (c) Speaker has secured written permission to use any third-party materials appearing in the Presentation Materials; (d) Speaker has the legal authority to enter into this Speaker Release Form; and (e) Speaker has read the AHLA Publication Guidelines for Authors (the “Guidelines”), the Presentation Materials have been prepared in accordance with the Guidelines, and Speaker is responsible for compliance with the Guidelines by anyone who assisted Speaker with preparation of the Presentation Materials. • Indemnification. Speaker agrees to indemnify, defend and hold harmless AHLA, its officers, directors, members, affiliates, successors and assigns, for any and all costs which arise out of any claim against AHLA regarding any third-party rights that AHLA is alleged to violate if such alleged violation resulted from AHLA’s use of the Presentation Materials or a breach by the Speaker of any representation or warranty contained in this Speaker Release Form. • Speaker understands that his/her signature below represents his/her acceptance of the foregoing terms and releases AHLA from any financial or legal responsibility for the use of his/her image, name, and likeness and/or the Recordings and/or the Presentation Materials as specified herein. Printed Name________________________ Signature____________________________ Date________________