Please complete all sections of this workshop speaker declaration and release form. Additional speakers in your workshop group/panel should also complete this form.
RWA membership number (if applicable):
First Name: Last Name:
The topic/title of my session is:
I agree to participate in the 2012 RWA Annual Conference as a workshop speaker. I affirm that the presentation is my own original work, and/or I have included written permission from the copyright holder to use his/her copyrighted work. This presentation does not infringe anyone else’s copyrights and is not defamatory. I agree to hold the association harmless from any lawsuits resulting from the inaccuracy or breach of these assurances.
The RWA office will be contacting you initially via e-mail to let you know the time and date of your workshop. Please verify your e-mail address. E-mail:
Please list a cell phone number that RWA can use if we need to contact you onsite at the Anaheim Marriott.
Cell Phone:
The following speakers will be participating in the workshop.
Wired microphones are provided for each workshop. If your workshop requires special audio-visual equipment please note your request below. Essential equipment will be supplied to the best of RWA’s ability. However, RWA accepts no responsibility for the unavailability of requested equipment.
RWA encourages participants to provide conference handouts. Please upload your handouts at the bottom of this form; or, e-mail one copy of your handout material by April 16, 2012, to workshops@rwa.org. Speakers will not be reimbursed for other copies or for material not provided by April 16, 2012.
Yes, I will have handouts.
Handout requirements: 1) Half-inch minimum margins top/bottom 2) One-inch minimum margins left/right 3) No page numbers on bottom of page 4) Put name of workshop as header on each page. 5) Speaker bios on handouts limited to 150 words per bio. I agree to grant RWA the right to include copies of my handout material on the RWA 2012 conference CDs/flash drives (if applicable), the RWA Web site, and with the audio recordings of RWA conference sessions. I understand that I retain all rights to the use, publication, and reproduction of this material. I further certify that all handout material is my own original work and/or that I have included written permission from the copyright holder to reproduce his/her copyrighted work. This work does not infringe anyone else’s copyrights and is not defamatory, and I have the full right and ability to make this license. I agree to hold the association harmless from any lawsuits resulting from the inaccuracy or breach of these assurances.
No, I will not have handouts.
As part of our continuing efforts to educate our members, RWA has arranged for conference workshops to be recorded on CDs and as MP3s. As contracted, CDs/MP3s will be available for purchase and are protected by copyright from any unauthorized use and/or duplication. Conference speaker fee waiver/rebate constitutes payment to the speaker. RWA requests your permission to have your workshop recorded. In presentations with more than one speaker, all participants must agree to be recorded. Please choose one of the following options:
Yes, I hereby consent to the recording and duplication of my 2012 RWA Annual Conference workshop.
I understand that by signing this release I am granting RWA the non-exclusive right to audiotape my presentation and use and/or sell the recording in any manner on a royalty-free basis following the presentation. I also understand that signing this release does not prohibit me from using my material in any way I choose at any future time.
No, I do not consent to the recording and duplication of my 2012 RWA Annual Conference workshop.
I recommend that RWA invite the following person to moderate my workshop. I understand that although RWA will try to arrange for this person to moderate the workshop in which I’m participating, this does not ensure that the person below will in fact be the moderator. *Note: Moderator requests will only be accepted from the main workshop speaker/contact.
Requested Moderator:
RWA policy allows a maximum speaker waiver/rebate of $120 per workshop divided equally among the speakers. This waiver applies only to individuals who pay the full conference registration fee. No individual speaker may receive more than $120 for the year. Note: For Eligible agents and editors from Qualifying Markets, the waiver is the discounted or waived conference registration fee. I understand that as a workshop speaker, the compensation that I am entitled to receive is a waiver/rebate from my conference fee. I understand that I must complete a conference registration form and the conference waiver will be refunded after conference.
RWA members must be registered to attend the conference. Speakers who fail to register by the conference registration deadline will be replaced.
Please provide the workshop committee with a copy of your most recent biography. This bio will be placed on the RWA website and read by the moderator at the beginning of your workshop(s), so please keep it to a readable length. RWA reserves the right to edit the bio for content or length. Upload your bio (in a document separate from your handouts) at the bottom of the form; or, e-mail it to workshops@rwa.org.
I do hereby affirm that the statements provided in my bio are true and accurate.
I would like the Book Fair vendor to order the books listed below for purchase at the Book Fair. I understand that the Book Fair vendor will make every ordinary effort to obtain sufficient copies of my work. However, the vendor can not guarantee availability, ship dates, etc. Please note: While RWA makes every effort to host a Book Fair at its annual Conference, it is not guaranteed.
Research Titles
Book Title:
ISBN:
Author:
Publication Date:
Publisher:
Author's Titles
Along with this form, please attach the following:
Please submit any questions to: workshops@rwa.org
