Forefront Event Speaker Information Form

Date of Event:

Which of the following programs are you participating in?

Member Network program
Philanthropy Club
Policy and Advocacy program
Misson Sustainability Initiative program
Racial Equity Collective program
Other

If your event was not listed above, feel free to enter here:

Speaker Name*

Please share the full name of the speaker.

What are your preferred pronouns?

Organization Name

Please provide the name of the organization, if any, the speaker is affiliated with.

Title of Speaker

What is the speaker's title at the affiliated organization?

Speaker's Email Address*

Your Email Address

If you are not the speaker, please provide your contact information.

Does the Speaker have a LinkedIn account they would be willing to publicly share with event attendees?*

Yes
No

LinkedIn Profile

Please share the URL of your LinkedIn profile. We'll share this in the event listing so attendees can learn more about you.

Do you have any food allergies or special dietary requirements? (Please be specific)

Which race or ethnicity best describes you? (Please choose only one.)

American Indian or Alaskan Native
Asian / Pacific Islander
Black or African American
Hispanic
White / Caucasian
Multiple ethnicity/ Other (please specify)

If you entered "Multiple ethnicity/ Other" above, please specify:

Speaker Biography*

Forefront usually shares the LinkedIn profiles of speakers and moderators so attendees may learn more about their work. In lieu of a profile, please provide a short biography of no more than 50 words.

Social Media Handles

Please list the speaker's social media handles including Twitter, Instagram, Facebook, LinkedIn, and any other applicable channels.

Is there anything Forefront should know about how to promote the speaker?

Please provide any specific naming conventions, capitalization requests, and so on. If the speaker would prefer not to be acknowledged in any particular way (for example, no social media mentions), please note that as well.

Headshot

Please upload a .png or .jpg file of your headshot. The higher the resolution, the better. Please ensure that images are not less than 400x400 pixels.

Drop files here or

Accepted file types: jpg, png, Max. file size: 30 MB.

Consent

RELEASE AGREEMENT

Whereas FOREFRONT is engaged in programming for our Member and Peer Network programming,

Whereas, I, the undersigned, have agreed to appear in the Video, and

Whereas, I understand that my voice, name, and image will be recorded by various mechanical and electrical means of all descriptions (such recordings, any piece thereof, the contents therein and all reproductions thereof, along with the utilization of my name, shall be collectively referred to herein as the "Released Subject Matter"),

Therefore, I hereby freely and without restraint consent to and give unto FOREFRONT and its agents or assigns or anyone authorized by FOREFRONT (collectively referred to herein as the "Releasees") the unrestrained right in perpetuity to own, utilize, or alter the Released Subject Matter, in any manner the Releasees may see fit and for any purpose whatsoever, all of the foregoing to be without limitation of any kind. Without limiting the generality of the foregoing, I hereby authorize the Releasees and grant unto them the unrestrained rights to utilize the Released Subject Matter in connection with the PROGRAM's advertising, publicity, public displays, and exhibitions. I hereby stipulate that the Released Subject Matter is the property of the Producer to do with as it will.

I hereby waive to the fullest extent that I may lawfully do so, any causes of action in law or equity I may have or may hereafter acquire against the Releasees or any of them for libel, slander, invasion of privacy, copyright or trademark violation, right of publicity or false light arising out of or in connection with the utilization by the Releasees or another of the Released Subject Matter.

It is my intention that the above-mentioned consideration represents the sole compensation that I am entitled to receive in connection with any and all usages of the Released Subject Matter. I expressly stipulate that the Releasees may utilize the Released Subject Matter or not as they choose in their sole discretion without affecting the validity of this Release. This Release shall be governed by Illinois law.

I hereby certify that I have read, understood, and agreed to the foregoing.

I consent.

I do not consent to the release.

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Speaker Information Form

Forefront Event Speaker Information Form

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