Annual Meeting Speaker - Video Release Form

63nd NATA Annual Meeting & Clinical Symposia


Check below to indicate accept or decline:

  1. You agree to allow Healthy Learning to videotape presentation referenced above at the 2012 NATA Annual Meeting & Clinical Symposia at no expense to you.
  2. The edited DVD and/or streaming video of presentation referenced above will subsequently be distributed and sold by both NATA and Healthy Learning.
  3. In return for granting permission to have presentation referenced above videotaped, you will be given two complimentary copies of your DVD. You may purchase additional copies of the DVD for any purpose (e.g., resale) at a 75% discount off the suggested retail price directly from Healthy Learning. You understand that you are not obligated to purchase any copies.
  4. In addition, you/your speaker panel will receive a 5% royalty based on all cash received from the sale copies of said session by Healthy Learning. The 5% royalty will be split equally among the speaker panel. You will not be paid a royalty on copies of your DVD sold at 75% discount. Royalties will be paid twice annually for sales during the previous six months.
  5. The copyright for your DVD will be filed by Healthy Learning in NATA’s name. You will retain complete ownership of any and all intellectual property included in presentation referenced above. Your participation in the project does not preclude your involvement in any other project involving the material included in this DVD.
  6. You agree to provide Healthy Learning with the following information prior to May 29, 2012 so that packaging for your DVD can be completed in a timely fashion: a 4-5 sentence description (overview) of your presentation; a 5-6 sentence personal biography; and a full-color personal photo. All items should be emailed to: Angie Perry at

    You also agree to provide NATA with 8 – 10 multiple choice and/or true/false quiz questions based on your presentation content by July 6, 2012. Your quiz questions should be sent to Anita James at

    Your Power Point presentation will be collected by NATA on-site and provided to Healthy Learning for integration with your filmed presentation.

  7. I agree to identify any content that is not obtained from a known open source or for which I do not have permission. Healthy Learning agrees to remove any images from the final product as requested by the speaker.
  8. Healthy Learning will format each DVD in universal code, making each DVD compatible for playing in all machines worldwide.

SSN*:     Your social security number will be collected post event in order to meet federal requirements for the payment of royalties.