Special Topics Member Speaker Release Form

Honorarium

NATA pays an honorarium to help compensate and thank presenters at NATA's educational endeavors.

Please check one of the boxes if you wish to donate all or part of your honorarium to the NATA Research and Education Foundation or the NATA Political Action Committee (NATAPAC).

I would like to donate [ Fill in text box below ]% of my honorarium to the NATA Foundation.

I would like to donate [ Fill in text box below ]% of my honorarium to NATAPAC.

Agreement

I am submitting material entitled [ Fill in text box below ] for my presentation at the 2012 NATA Annual Meeting and Clinical Symposia.

Material means printed, electronic, verbal, audio, audio visual and other forms of information used in or for this presentation. I grant NATA permission to use the material as it sees fit. This may include, but is not limited to:

  • Publication in a proceedings or similar document.
  • Posting on a web site for event attendees to access and utilize.
  • Recording or filming all or portions of my presentation; combining these recordings or film with other recordings, film, text or graphics.
  • Distributing or selling these recordings, films or resources to members or others.

Signatory

This form should be completed by:

  • The author of the information submitted.
  • The employer in the case of a "work for hire".

I understand signing this release in no way prohibits me from using my own material in any way I so desire. I understand this submission does not guarantee its publication or posting if materials do not meet NATA's quality standards.

Permissions

If this material contains copyrighted information that is not my own, I am responsible for obtaining reprint or use permission and will do so for the purposes described above.

If (parts of) this material have been produced by multiple authors, I will inform the co-authors of this usage and obtain any additional permission needed. I have obtained any necessary permissions from individuals pictured in the materials.

I am authorized to sign this form and agree to the conditions outlined above.

If you decline to agree to any of the terms listed above, please select the button below and contact Velma Meza at velmam@nata.org or 972-532-8850 immediately.