Speaker Form Please complete this form for The Adult ADD Holistic Summit. Name* First Last Phone*Email* Assisstant's Name (If you have one) First Last Assistant's Email (If you have one) Short Bio*Upload Headshot*Free Gift Title (required)*Free Gift URL (required)* Suggested Interview Title*Description of the 3 main points you would like to make during your interview. If you would prefer for specific questions to be asked, please enter them here.*Speaker Release for the Adult ADD Holistic Summit.* I agree to the release form below.Speaker Release for the Adult ADD Holistic Summit. George Sachs PsyD desires to electronically record speaker’s presentation/interview video recording. Guest/Speaker understands that for educational, presentational and commercial applications, George Sachs PsyD will make Speaker’s presentation/ interview video recording available at no charge for attendees of this virtual event. Guest/Speaker hereby grants to George Sachs PsyD the right to use his or her name, voice, appearance, likeness, image, words, participation and title or professional designation, in whole or in part, in these recordings and/or compilations and in any correspondence, publicity, advertising, promotional or other derivative materials based on them. This includes posting the video on Youtube. George Sachs PsyD has no obligation to make use of the rights granted herein. Guest/Speaker hereby grants George Sachs PsyD the unconditional and irrevocable right to reproduce the recording in any format, and to distribute, sell, prepare, derivative works, advertise, and publicize the recordings without compensation to the Guest/Speaker(except entitled affiliate commission detailed in #5 below.). George Sachs PsyD may edit the recordings at her discretion. George Sachs PsyD shall own the worldwide rights, title, and interest, including copyright in, and to, the Guest/Speaker recording. However, Guest/Speaker shall also retain the right to use his or her own recording for any purpose. Guest/Speaker, upon written request to George Sachs PsyD, shall be provided with a copy of his or her recording in electronic format. Guest/Speaker agrees to send the minimum of 2 (two) emails to their whole database promoting the event during the agreed-upon period. The Guest/Speaker also agrees to send 1 (one) newsletter blurb and promote on all available social media outlets during the promotion period. Guest/Speaker is permitted to make a FREE offer during his or her presentation/interview. Guest/Speaker represents that he or she has the full right, power and authority to grant this release and to perform all of the provisions there of. Guest/Speaker acknowledges that in the event of a breach or alleged breach with respect to the terms and provisions hereof, that George Sachs PsyD shall be entitled to such injunctive or equitable relief as George Sachs PsyD may deem appropriate, in addition to such other rights or remedies George Sachs PsyD may have at law. Guest/Speaker agrees to indemnify to hold harmless George Sachs PsyD from and against all claims, losses, expenses, and liabilities of every kind including reasonable attorney’s fees arising out of the inaccuracy or breach of any provision of this Agreement. Guest/Speaker expressly releases George Sachs PsyD from any and all claims arising out of the use of the material. This release shall be governed in accordance within the state of New York law, constitutes the entire agreement of the parties, and may be amended only in writing. By submitting this form and agreement, you indicate your understanding and agreement with the terms of this release.