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Speaker Permission to Audio/Video Consent Form
Sponsor: GWU CME Conference: William M. Steinberg Board Review in Gastroenterology and Best Practices Course Conference Dates: August 21 - 23, 2021 SPEAKER PERMISSION TO VIDEO AGREEMENT AND CONSENT FORM William M. Steinberg, MD, President of Capital Academics LLC (“Capital”), on behalf of the GWU CME and “Capital” intends to videotape and audiotape, reproduce, publicly perform or display, and distribute the 2019 William M. Steinberg Board Review in Gastroenterology (“Video/Audio Program”) as a CME enduring material. In addition, “Capital” intends to reproduce the written syllabus and slides submitted by each faculty speaker as educational material for the audience and to reproduce parts of the written material for online educational purposes. Questions that are created by the faculty may be used on the website www.giboardreview.com. I have been invited by William M. Steinberg, MD, Course Chair, to be a presenter at the above referenced conference. In consideration of the above, I authorize “Capital” to videotape and audiotape my complete presentation(s) and consent to allow “Capital” the use, public performance and display, reproduction and distribution of my name, presentation(s) and all materials associated with my presentation(s) including handout materials and slides. I release and assign to “Capital” all rights I may have in the “Video/Audio Program” of the conference and in the copyrights related to the “Video/Audio Program.” In addition, I give permission to “Capital” to distribute my handout materials and slides to the educational audience and to allow publication of any of my created questions to be put online. I understand that a royalty on the sales of "Video/Audio" may (or may not) be paid to me at a later date depending on sales of the total program (live course + video/audio). This will be determined by "Capital" each year. I have reviewed the GW guidelines concerning copyright policies  and agree to abide by these. I agree that “Capital” makes no claim as to the validity of the medical or legal content of the Conference or of the Video/Audio Program thereof and relies on my professional expertise in making my presentation(s). As an accredited sponsor of continuing medical education, GWU CME will ensure that these materials will be produced in compliance with the Accreditation Council for Continuing Medical Education (ACCME) Essentials and standards. This agreement shall be governed by and subject to the laws of the State of Maryland without regard to conflicts of laws principles and is the entire agreement on this subject among “Capital” and the GWU CME and the undersigned. This agreement may only be modified in a writing signed by all parties.
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