CCA Speaker Release Form
This release is provided to you as a speaker at the below referenced program(s)/event(s) to make certain that both you and the Simons Foundation (defined below) are assigned the necessary rights and have the protections as follows:

1. I give permission and authorize The Simons Foundation, Inc. (which includes the Flatiron Institute) and its agents, authorized third parties, designees or representatives (collectively, the “Simons Foundation”) to take photographs, transcribe, and/or record in audio, audio-visual or other format (the “Recording”) my presentation and any supporting materials shown or made available during my presentation (“Presentation”).

2. I agree that the Simons Foundation, in capturing the Presentation, is the owner of all right, title, and interest in the Presentation, including, but not limited to the copyright in the Recording. However, I will retain the copyright to my original content captured in the Recording. Nothing in this release transfers ownership of my ideas or research to the Simons Foundation.

3. I understand and agree that as the Recording copyright owner, the Simons Foundation will have full rights to use the Recording, including without limitation, the right to:
-- use, display, edit, duplicate, and/or distribute the Recording (including on websites, digital properties,
informational, educational, advertising, or promotional materials, and/or any other delivery to the public), in
whole or in part, in perpetuity and throughout the world in any medium now known or later developed;
-- use my name, title, image, likeness, and biographic information to use, promote or exploit, in whole or in
part, the Recording; and
-- use the Recording to promote or advertise the Simons Foundation, and for any purpose pursuant to its
charitable mission.

4. I verify that the Presentation is original, not defamatory, and does not infringe the copyright or violate the rights of any third parties and that I have the right and permission to enable the use of the Recording consistent with this release for any third party materials contained in the Presentation;

5. I will indemnify and hold harmless the Simons Foundation, its officers, trustees, directors, agents, and employees against any and all claims, liabilities, costs and expenses, losses, or damages arising out of my Presentation and/or any breach of this release and the representations and warranties contained herein; and

6. I agree that this release shall be governed by the laws of the State of New York, is a legally binding agreement, and shall inure to the benefit of the Simons Foundation and its licensees, successors, and assigns.

Full Name *
As it appears on your Passport / ID
Your answer
Current Date *
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DD
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YYYY
Program or Event Name *
e.g. CCA Colloquium
Location *
Date(s) of Workshop *
Check one *
By checking I AGREE you agree to be bound by the terms and conditions of this release, and declare that you have read the above, fully understand its meaning and effect, and have the authority to enter into this release.
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