Speaker Release form for the 2020 Reverse Autoimmune Disease Summit
Autoimmune Disease Detox
Thank You for participating in the Reverse Autoimmune Disease Summit: Autoimmune Disease Detox. Please complete this form to access your interview booking link.
Participation in the summit will include electronic recording of the Guest/Speaker presentation and interview with Dr. Keesha Ewers. Guest/Speaker understands that for educational, promotional, and commercial applications, Dr. Keesha Ewers will make Speaker’s presentation/interview video recording available at no charge to summit registrants.
Guest/Speaker hereby grants to Dr. Keesha Ewers the right to use his or her name, voice, appearance, likeness, image, words, participation, and title or professional designation, in whole or part, in these recordings and/or compilations and in any correspondence, publicity, advertising, promotional, or other derivative materials based on them. Dr. Keesha Ewers has no obligation to make use of the rights granted herein.
Guest/Speaker hereby grants Dr. Keesha Ewers the unconditional and irrevocable right to reproduce the Recording in any format, and to distribute, sell, prepare derivative works, advertise, and publicize the Recordings without compensation to Guest/Speaker. Dr. Keesha Ewers may edit the Recordings at her discretion. Dr. Keesha Ewers shall own the worldwide rights, title, and interest, including copyright in, and to, the Guest/Speaker’s Recording. However, Guest/Speaker shall also retain the right to use his or her own Recording for any purpose.
Guest/Speaker, upon written request to Dr. Keesha Ewers, shall be provided with a copy of his or her Recording in electronic format.
Guest/Speaker agrees to send the minimum of 2 (two) solo emails to their whole database during the agreed-upon promotion period. The Guest/Speaker also agrees to make at least 1 (one) promotional post on all available social media outlets during the promotional period.
Please check the box below to confirm that you agree with point 4.
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I Confirm That I Will Perform all promotional activities state in point 4.
Guest/Speaker is permitted to make a FREE offer during his or her presentation/interview including the provision of a URL or other traffic destination.
Guest/Speaker represents that he or she has the full right, power, and authority to grant this release and to perform all of the provisions thereof. Guest/Speaker acknowledges that in the event of a breach or alleged breach with respect to the terms and provisions hereof, that Dr. Keesha Ewers shall be entitled to such injunctive or equitable relief as Dr. Keesha Ewers may deem appropriate, in addition to such other rights or remedies Dr. Keesha Ewers may have at law.
Guest/Speaker agrees to indemnify and hold harmless Dr. Keesha Ewers from and against all claims, losses, expenses, and liabilities of every kind including reasonable attorney’s fees arising out of the Inaccuracy or breach of any provision of this Agreement. Guest/Speaker expressly releases Dr. Keesha Ewers from any and all claims arising out of the use of the material.
This release shall be governed in accordance within the state of Washington law, constitutes the entire agreement of the parties, and may be amended only in writing.
By completing and submitting this form, you confirm understanding and agreement to all terms and conditions stated above and confirm the accuracy of the information provide.
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I confirm that by completing this form, I am also agreeing to be an Affiliate for the The Reverse Autoimmune Disease Summit: Autoimmune Disease Detox.
Your Name
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First
Last
Your Contact Email Address
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PayPal Email Address (This is where commission payments will be sent to.)
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Your Primary Website URL
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Facebook Page
Upload Your Preferred Headshot (minimum 400x400 pixels)
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Your Bio (How you want to be introduced during the summit interview)
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Assistant/Point Of Contact Name
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Assistant/POC Contact Number
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Assistant/POC Email
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List Size
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Affiliate Signup URL:
Please enter the link here for us to sign up as a reciprocal affiliate
Signature
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Date
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Date Format: MM slash DD slash YYYY
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Marketing Information
Date #1 for emailing your list about this event (should be between 03/29/2021 and 04/4/2021):
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Date Format: MM slash DD slash YYYY
Date #2 for emailing your list about this event (should be between 04/5/2021 and 04/11/2021):
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Date Format: MM slash DD slash YYYY
Email is often the best means of driving traffic to an event, so we assume that these are part of your promotional strategy. If you are using other channels, please let us know below:
Social Media
Blog Post
Paid Advertising
Webinar
Other
Do you intend to promote on the day of your talk?
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Yes, I will promote via email
Yes, I will promote via social media
No or does not apply to me
If you have affiliates in your database, it is very worthwhile to send a dedicated email to them about being an affiliate for this event. Plus, you will earn 10% of all packages they sell.
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Yes, I have an affiliate segment and will promote being affiliates to them.
No, I either don't have an affiliate list or will not promote being an affiliate to them.
I would like more information on how to successfully run a tier 2 campaign.
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Speaker Gift Bonus
Do you have a gift that you can share to the Summit Attendees?
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Yes
No
Title of Gift
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Product Image
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Retail Value
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Minimum value: $25
Description of Gift
Link to file
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Gift Code (if applicable)