Speaker Name

Title

Institution

Address

Email

Telephone (xxx-xxx-xxxx)

Presentation Information

Presentation Title

Program Title

Date(s) (xx/xx/xxxx)

Location

Release Agreement

I agree to participate as a speaker for Stanford Sports Medicine in reference to the above listed program

I grant Stanford Sports Medicine the right to use my name, voice and presentation content, if Stanford Sports Medicine so chooses

I warrant that my presentation and any material(s) I submit do not infringe on the rights of others

I agree to obtain such permission(s) from the copyright owner(s) should my presentation or the material(s) I use during or in connection with my presentation require permission for use

I understand that execution of this Agreement does not obligate Stanford Sports Medicine to publish my presentation or the materials used therein

I verify that I am the author of this presentation, I have authority to enter into this agreement and that I will be bound by its terms