HHS National Conference on Women’s Health Speaker Registration
You are being asked to create a password for registration. The password acts as a security key that confirms the person logging in is the same person who registered.
First Name
Last Name
Password
Email
Phone Number
Title/Position
Institute/Company Name
Assistant's Name
Assistant Email
Speaker Page Information
Please Provide a Short Bio (no more than 250 words)
Session Information
Session Title (this information will be used on the conference agenda)
I, the undersigned, hereby grant HHS NCWH (“the Organizer”) permission to record, photograph, and/or otherwise capture my presentation, likeness, voice, and presentation materials during the above-named event. I understand and agree that: The Organizer may use the recordings, photographs, and presentation materials (including slides) for educational, promotional, archival, and informational purposes. These materials may be edited and shared publicly through various media, including websites, social media, newsletters, and future conference promotions. My name, title, and organization may be used in connection with my recorded presentation. The Organizer may post the recording and/or slides in whole or in part for attendee access or educational purposes following the event. I will not receive compensation for the use of these materials. I represent that the content of my presentation and slides is my own or that I have obtained all necessary permissions for its use. I release the Organizer and its representatives from any liability arising from the use or distribution of the recorded or related materials as described above.
Speaker Video Release Information
Consent to Speaker Video Release
