Keynote and Symposia Speaker Form

Session Information

Please select your session from the list below:*

Contact Information

Has your contact information changed recently?*

Yes
No

Name

First Last

Email Address*

Alternate Email Address (or Admin Assistant email)- Optional

Institute*

Department

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Emergency Contact Name*

Emergency Contact Phone Number*

Permission Releases and Electronic Signature

Photography Permission Release (You must check the box below to agree and be eligible to attend the meeting)*

Photographs will be taken at the 2019 ASCB|EMBO Meeting. By checking this box, and attending the meeting, I agree to allow the ASCB and/or EMBO to use my photo in any ASCB-related or EMBO-related publications or on the ASCB or EMBO website.

Attendance Permission Release (You must check the box below to agree and be eligible to attend)*

By checking this box, I agree to indemnify and hold harmless the ASCB and EMBO and their governing bodies, officers, directors, employees, and/or agents from all loss, damage, or liability arising out of or related to my attendance at the 2019 ASCB|EMBO Meeting. I assume all risks associated with my attendance and participation in on- and off-site activities.

Travel Reimbursement Agreement*

By checking this box, I acknowledge that I have read and understand the reimbursement guidelines as provided to me in the invitation letter and again in the logistics letter sent in early summer from Alison Harris.

Privacy Policy*

By checking this box, I have read, understand, and agree to the ASCB's Privacy Policy.

Click here to view the ASCB Privacy Policy.

Audio/Videotape Clearance

The American Society for Cell Biology (ASCB) may audiotape and/or videotape the session in which you appear as a speaker for the benefit of meeting attendees and others interested in the content of the sessions. The dissemination of audio and video via the ASCB website has proved to be a valuable addition to the benefits provided by the Society. Before we can disseminate the audio or video of the session, we require a signed release from you.

I hereby give consent to and authorize the ASCB and its licensees to make recordings and transcriptions of that part of the 2019 ASCB|EMBO Meeting, and to sell, use, and reuse the program and recordings in whole or in part, in any media now or hereafter known. It is acknowledged that there will be no compensation for granting permission or from the proceeds of the tapes.

It is hereby acknowledged that any opinions expressed are the sole responsibility of the undersigned and in no matter reflect policies or opinions of the ASCB .

It is understood that in the event that any materials used in this presentation contain the work of other individuals or organizations, it the responsibility of the undersigned to secure any necessary permissions and/or licenses.

Providing consent is not a requirement to speak at the meeting. If you choose not to consent, we will not disseminate your presentation.

I consent to the Audio/Videotape Clearance above?*

Yes
No

Electronic Signature

In accordance with federal law, the party executing this Agreement electronically - binding the party to the same degree as a handwritten signature - by using the following process to create an electronic symbol signifying intent to be legally bound. The signer must fill in the name, institute, and date below, and check the checkbox at the end of the line marked “Electronic Signature."

The signor shall retain a paper copy of the electronic mail.

Approved and Authorized by:

Print Full Name for Signature*

Institution*

Signed Date*

Electronic Signature (Check the Box)

Hotel Reservation

A complimentary sleeping room reservation will be made for you as indicated in the letter sent to you regarding logistics in early June. You will be sent hotel confirmation in November. Additional room nights and all personal incidental charges (phone, movies, room service, etc.) to the sleeping room are your responsibility and must be paid upon check-out. Please Note: if you reside within 50 miles of the Walter E. Washington Convention Center, a sleeping room will only be provided for 1 night.

Room Type Preference*

Single (one bed, one person)
Double (one bed, two people)
Double/Double (two beds, two people)
No Room Required

Please provide the name of the person you will be sharing the room with:

Arrival Date*

Departure Date*

Please provide any additional hotel requests here and we will do our best to accommodate them:

Accessibility (Americans with Disabilities Act)

The ASCB will work to ensure accessibility for people with special needs. If you require special accommodations, auxiliary aids, or services, let us know. Our meetings department will contact you to best determine your needs.

Please contact me regarding special needs under the ADA Act?*

Yes
No

Presentation Preferences Information

Standard equipment available in each session includes:
- Screen - Video/data (LCD) Projector - Projection Operator - MAC Computer, with mouse - Lighted Lectern with Microphone and Confidence Monitor - Lavalier Microphone - Video Switcher - Laser Pointer (in many rooms this is the mouse due to multiple screens) - Timer We strongly encourage presenters to bring their presentations to the Speaker Lounge in Room 103A, at least an hour prior to your session, even if you plan to present from your own laptop so we can ensure the formatting will display correctly on our equipment during your talk.

I will present from my own laptop. We STRONGLY discourage this option due to issues with compatibility especially with non-U.S. laptops.*

Yes, and I understand that I may need to upload my files if my laptop is not compatible.
No

My computer preference is:*

MAC
PC

My presentation is in:*

PowerPoint
Keynote

Is there any other equipment not listed above that you will require for your presentation? Please list it in the box below and we will do our best to accommodate you.

I agree to stop by the speaker lounge at least 1 hour prior to my talk (for Symp speakers we request you stop by the afternoon prior to your talk) to ensure my presentation will display properly.*

Yes, I agree

CAPTCHA

2019 ASCB|EMBO Keynote and Symp Speakers: Please fill out the form below.

Session Information

Contact Information

Permission Releases and Electronic Signature

Audio/Videotape Clearance

Electronic Signature

Hotel Reservation

Accessibility (Americans with Disabilities Act)

Presentation Preferences Information