NVTC Speaker Consent Form






*Company Communications Representative Name

*Company Communications Representative Email:

Personal Twitter Handle:

Company Twitter Handle:

Personal LinkedIn Page:

Company LinkedIn Page:

Media Coverage:

The event will be open and promoted to the media. Please note below your willingness to participage in media outreach before, during and after the event:

Are you willing to participate in a phone interview with non-local reporters before/after the event?

Are you available/interested in talking to media on-site during the event?

NVTC records the audio of its events as a member resource. The audio recording may be published on the NVTC website and promoted through NVTC communications channels. By speaking at the event, you acknowledge that the information you are sharing is not confidential and can be shared.

If you have any concerns about your remarks being recorded or covered by the media, please contact Kara Mauceri, KMauceri@NVTC.org

As an industry thought leader, would you also be interested in sharing your insights in NVTC's all digital The Voice of Technology magazine?

* By clicking submit I hereby consent to and authorize the use and reproduction, in print or electronic format, by NVTC or its authorized agents, of any and all photographs, audio or video which may be taken of me and/or my company at this event, for any publicity purpose, without compensation. I acknowledge and agree that all images, whether electronic, negatives and positives or otherwise, together with the prints, are owned by NVTC. I hereby acknowledge that I am 18 years of age or older and have read and understood the terms of this authorization and release.