ISGL Speaker Release Form
This Speaker Release is provided to the Islamic Society of Greater Lowell (hereafter referred to as “ISGL”) with respect to the following lecture (hereafter referred to as "Lecture"):
Title of Lecture *
Your answer
Name of event *
Your answer
Date of event *
MM
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DD
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YYYY
Venue of event *
Your answer
Speaker Release and Acknowledgement
By signing below, I authorize ISGL, free of charge and without limitation, to photograph, record, publish, or otherwise copy the Lecture. I understand that the Lecture may be broadcasted, displayed, reproduced, edited, or distributed including any derivative works created from or with it, over television, cable, the Internet or any other communication medium now existing or hereafter created.

ISGL also retains the discretion to choose whether to archive the footage, and whether to use it for any other purpose.
This authorization explicitly includes the use of my name, likeness, voice and/or biographical information for publicizing the broadcast, telecast, distribution, publication or exhibition of the specified program or portions thereof.
The Lecture and any associated materials are my own original material or material for which I have full authority to grant the rights set forth in this Speaker Release.

I acknowledge that I take full responsibility of claims, opinions and thoughts expressed in the Lecture. I also acknowledge that these claims, opinions and thoughts are solely my own and do not reflect the official opinion of ISGL and hence ISGL will not be held accountable or liable for them.

This Speaker Release supersedes all prior agreements pertaining to its subject matter and cannot be amended without the written, signed agreement of an authorized representative from the ISGL Board of Directors.
Name of Speaker (Digital Signature) *
Your answer
Address *
Your answer
Phone Number *
Your answer
Date *
MM
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DD
/
YYYY
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