Monthly Presentation Proposal Form Please fill in all fields of the form and click the Send button when done. Title of Presentation/Panel(Required) Type Presentation Panel Presenter(s)(Required) Who will be presenting? If it is a presentation by multiple people or a panel of several people, please include all names separated by commas.Presenter(s) Email(Required) If multiple people are involved with the presentation or if it is a panel, please provide an email address for everyone, if possible. Separate emails by commas.Presenter's Phone Number(Required)Please provide us with at least one phone number.SRS Member(s)? Yes No Proposed Date of Presentation/Panel(Required) MM slash DD slash YYYY Presentations/panels are usually on the third Friday of the month from 1-3pm.Hosted By(Required) Who from SRS is hosting you?Audio visual needs for the presentation (If none put None)(Required)Description of Presentation(Required)Presenter's Biographical Information(Required)Please provide us with your biographical information. Also, please send us a photo of yourself to use in our promoting your presentation. Send us your photo by email to srs@srsedc.org. By sending us your photo, you give us permission to use your photo to promote your presentation. If multiple people, please provide information (and photos, if possible) about each person.Consent(Required) I Give Sierra Renaissance Society Consent to Distribute, Reproduce and Publish.The Sierra Renaissance Society (SRS) of Placerville, California (501c(3) is a group of El Dorado County older adults who want to learn about new topics, meet new people, and learn. Among the events are speakers and workshops. As a presenter, I have been invited to speak to an assembly of SRS and agree to do so. Therefore, I hereby give permission to Sierra Renaissance Society to distribute, reproduce and publish the video and/or audio recording of my speech and presentation to the SRS. I hereby grant to the SRS the absolute and irrevocable right and unrestricted permission to use my name, likeness, image, voice, and/or appearance as such may be embodied in any photos, video recordings, audiotapes, digital images, and the like, taken or made on behalf of the SRS. I acknowledge that I will not receive any compensation for the use of such images, video, likeness, etc. I hereby release and discharge the SRS, and its agents, or representatives and assignees from all claims and demands arising out of or in connection with the use of my name, likeness, image, voice and/or appearance, including any and all claims for invasion of privacy, right of publicity, misappropriation or misuse of image, and/or defamation. As a presenter, I represent that I am over the age of eighteen (18) years and that I have read the foregoing and fully understand its contents. This release shall be binding upon me, my heirs, legal representatives, and assigns. This agreement is being made and entered into under the laws of State of California and shall be governed and interpreted in accordance with the laws of said state. This agreement embodies the entire agreement of the parties. No modification of this agreement shall be of any effect unless it is made in writing and signed by all parties to the agreement. Δ
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