Speaker Release Form

Please complete the form below to indicate your agreement to have your video made available online on mathtube.org and other related PIMS websites.

I hereby give the Pacific Institute for the Mathematical Sciences ("PIMS") permission to use images of me (including any motion picture or still photographs made by PIMS of my likeness, poses, acts and appearances or the sound records made by PIMS of my voice ("Images") for any purpose in connection with promoting PIMS and its activities (the "Purposes"), which may include advertising, marketing and promotion. PIMS may crop, or alter such Images of me without notifying me.

I understand that my personal information, including images of me, is being collected pursuant to section 26 of the Freedom of Information and Protection of Privacy Act, R.S.B.C. 1996, c. 165 for the Purposes. I consent to my name and any other information provided by me to PIMS being displayed in connection with the appearance of my Image. I consent to any of my personal information, including Images of me, being stored, accessed or disclosed outside of Canada.

I am 19 years of age or older and am competent to sign this contract in my own name. I have read and understood this form prior to completing it, and am aware that by completing this form I am giving permission to PIMS to use my Images for the Purposes.

Except where explicitly noted, the works on mathtube.org are licensed under a Creative Commons License. To. All due credit will be given to speakers.

Any questions about the recording should be directed to PIMS via events@pims.math.ca. A pdf version of this form is also available. If you prefer, please sign, complete and return the form by email to events@pims.math.ca.

If this lecture was part of a larger event, please give the name of the conference or event.

I hereby agree to the conditions above and give permission for PIMS to use my Images.

This question is for testing whether you are a human visitor and to prevent automated spam submissions.