FWA - Speaker Information Form
Speaker Information for Website
Address Line 2
State / Province / Region
ZIP / Postal Code
Headshot- *Please name file first and last name*
Max. file size: 2 GB.
Professional Profile (Firm Website or LinkedIn)
Are you planning on attending the opening reception on March 1st?
Are you planning on attending the peer dinners (Dine-Arounds) on March 2nd?
(Family Office Executives Only)
Would you prefer a printed or digital program?
Are you planning on staying on site at The Phoenician?
Do you have any dietary restrictions?
Day of Event Contact Information
Day of Event Contact Information- Cell #
Day of Event Contact Information - Email
Speaker Release Agreement
Speaker Release Agreement
This Speaker Release and Consent Form (the “Release”) is provided to Family Wealth Alliance, LLC (the “Company”). By agreeing to speak, I grant the Company permission, free of charge and without limitation, to photograph, record, publish, or otherwise copy such my presentation. I further grant the Company a royalty-free and unlimited license to broadcast, display, reproduce, edit, exhibit and distribute the presentation and any derivative works created from or with it by any other communication medium. The Company also retains the right, at its sole discretion, to choose whether to archive the footage, and whether to use it for any other purpose. The authorization explicitly includes the use of my name, likeness, voice and/or pre-approved biographical information for the purpose of publicizing any broadcast, webcast, distribution, publication, or exhibition of the specified program or portions thereof. The Company, by capturing the presentation (“Recording”), will become the copyright owner of that Recording. To the extent that I have any rights in the Recording, I hereby assign all rights, title and interest in the Recording to the Company. The presentation and any presentation materials are my own original material or material for which I have full authority to grant the rights set forth in this Speaker Release. This Speaker Release and Consent supersedes all prior agreements pertaining to its subject matter and can only be amended by written agreement with the Company.
Waiver of Liability and Indemnity Related to COVID-19
FWA has taken enhanced health and safety measures—for you, other attendees, and staff. You must follow all posted instructions while visiting FWA events and activities. An inherent risk of exposure to COVID-19 exists in any public place where people are present. COVID-19 is an extremely contagious disease that can lead to severe illness and death. I acknowledge that participation in FWA events and activities brings some risk and I do hereby assume responsibility for my own well-being. I will follow all Centers for Disease Control and Prevention (CDC) guidance, and all posted instructions while visiting FWA events and activities. I understand, agree and hereby consent that my failure or disregard to follow all protocols in effect and required by FWA, CDC, the venue provider and governing authorities during my attendance at FWA is hereby sufficient grounds to be excluded from attending the event by FWA or an event authority, and I hereby consent in advance to leave and exit the event, without protest or refund, upon request by FWA or an event authority due to my refusal to follow said protocols.
Assumption of Risk
I have read and understood the above warning concerning COVID-19. I hereby choose to a accept the risk of contracting COVID-19 for myself in order to attend a FWA conference and enter into the conference premises. The conference is of such value to me that I accept the risk of being exposed to, contracting, and/or spreading COVID-19 in order to attend in person.
Waiver, Release, and Indemnification
As a condition of my participation in this meeting or event, I, do hereby expressly waive any rights against and release and hold harmless FWA and any of its employees, affiliates, contractors, and assigns (collectively “FWA”) from and against any and all claims, suits, demands, losses, damages, expenses, or liability of whatever kind or nature (collectively “liability”), under any theory of law or equity, that may arise during or as a result of my presence at the premises, including but not limited to any such liability related to or arising out of illness, injury, or death associated with infection of COVID-19 or complications, symptoms, or other effects resulting from contracting COVID-19. I shall defend, indemnify, and hold harmless FWA and all other Releasees against any and all losses, damages, liabilities, deficiencies, claims, actions, judgments, settlements, interest, awards, penalties, fines, costs, or expenses of whatever kind, including attorney fees, fees and the costs of enforcing any right to indemnification under this Agreement, and the cost of pursuing any insurance providers, arising out or resulting from any claim of a third party related to the Activities.
BY COMPLETING THIS SPEAKER FORM AND/OR REGISTRATION FOR THIS EVENT, I HAVE CAREFULLY READ AND FULLY UNDERSTAND ALL PROVISIONS OF THIS RELEASE. AND FREELY AND KNOWINGLY ASSUME THE RISK AND WAIVE MY RIGHTS CONCERNING LIABILITY AS DESCRIBED ABOVE