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Event Speaker Form - Mammography Workshop 2025

Name and Designation (as you would like it to appear on our website) (Required)

Email (Required)

Mobile Phone (Required)

Organization/Institute of Employment (Required)

Title (Required)

Education (Highest Degree) (Required)

Membership in Professional Organizations (Required)

Commercial Affiliations and Potential Conflicts of Interest (Required)

Bio / Short Statement of Experience / Publications / Certifications Relating to Activities in this Program (Required)

Headshot (Required)

YesNo

I provide COMP with permission to use, share, and distribute my presentation, materials, including any handouts and presentation slides. I also consent to the video recording of my presentation (speaker and slides) for inclusion in COMP's virtual library on the website and accessible for education purposes. This is done with the understanding that I will be properly credited for my work. I acknowledge that this agreement doesn't alter my copyright ownership of the presentation. It also doesn't restrict me or others from using the presentation in the future.

YesNo

To the best of my knowledge, my presentation does not violate any proprietary or personal rights of others (including any copyright, trademark and privacy rights), is factually accurate, and contains nothing defamatory or otherwise unlawful. I have the full authority to enter into this agreement and have obtained all necessary permissions or licenses from any individuals or organizations whose material is included or used in my presentation. (Required)

YesNo

I authorize COMP and its affiliates to use my name, likeness, photograph, and biographical data in connection with the use and promotion of this conference. (Required)

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