Panelist and Moderator Agreement for the 2022 APFM Annual Conference

Are you a Solo Presenter, Panel Moderator or Panelist?

Solo Presenter

Panel Moderator

Panelist

Speaker Info

First Name *

This will be listed on all conference materials.

Last Name *

This will be listed on all conference materials. Please include all designations.

Textable Phone Number *

We need a phone number to which we can text you on the day of the session.

Email *

Confirm Email *

Speaker Bio

0 of 250 max words

Please include your short professional bio - no more than 250 words

Speaker Profile Picture

Maximum upload size: 2MB

Please upload your most current professional headshot (in JPEG or PNG format). If you are unable to upload through this form for any reason, please email your headshot ASAP to: [email protected]

Speaker Agreement

Please confirm your agreement with the statements below.

Participation *

I will speak as a presenter, moderator or panelist on the session that I have been invited to join.

Technology *

I will join the panel via Zoom, using a device with a camera, microphone, and stable internet connection. I will use the Zoom link provided to me and I will not share that link with any person.

Expenses *

I understand that any expenses incurred to participate in this conference are my responsibility, and I will not be reimbursed by APFM.

Registration *

I understand that if I wish to attend other conference workshops, I will need to register for the conference with the 20% discount code provided to me.

Notification *

I will notify APFM immediately in the event that I am unable to meet my commitment as a speaker and understand that APFM is counting on me to present at the conference.For questions, please contact APFM at [email protected] or 802-823-2566. For questions, please contact APFM at [email protected] or 802-823-2566.

For questions, please contact APFM at [email protected] or 802-823-2566.

Content *

I warrant and represent that, to the best of my knowledge, nothing in my presentation violates any proprietary or personal rights of others (including, without limitation, any copyright or privacy rights), is factually accurate, and contains nothing libelous or otherwise unlawful.

Release

I AGREE THAT THE ACADEMY OF PROFESSIONAL FAMILY MEDIATORS MAY:

Use of Name and Bio *

Use my name, headshot and biographical data in any promotional material (print or online) developed in connection with the conference.

Use of Content *

Reproduce and republish in print, recorded media or online the presentation and remarks of my presentation. For example, video or audio files of my presentations may be provided to conferences attendees free or for a charge. Additionally, the video or audio recording may be given or sold after the conference.

Use of Content for Members *

Reproduce and republish in any form and in any media tables, charts or other written or visual material used by me as part of my presentation for the benefit of APFM members. In addition, any media tables, charges and other written or visual material from a presentation may include as part of a sale of the video or audio recording after the conference to the APFM membership or members of affiliate organizations.

Understanding *

I understand and agree to the above conditions.

Questions, please contact:

Kacy Wiant, APFM Administrator
[email protected]

Signature and Agreement Submission

Today's Date *

Signature *

Clear

Captcha

If you are human, leave this field blank.

Panelist and Moderator Forms

APFM 2023 Conference Speaker Agreement

Speaker Info

Speaker Agreement

Release

Questions, please contact:

Signature and Agreement Submission

Pin It on Pinterest