LIMITED SPEAKER RELEASE AGREEMENT By electronically signing below, you are making a legal agreement between yourself and Bellevue Breakfast Rotary Club. If you have questions about what this agreement means, please be sure to contact us prior to signing. This agreement is legally binding, so do not sign it unless you understand it fully and are comfortable with it. GRANT For good and valuable consideration of delivering a presentation or performance produced by Bellevue Breakfast Rotary Club (“The Event”), the sufficiency of which I (“The Speaker”) acknowledge, I hereby grant to Bellevue Breakfast Rotary Club and its assigns, licensees, and successors the following royalty-free rights throughout the world and in perpetuity: The right to use my name, voice, photograph, likeness, and biographical information in all forms and media including composite or modified representations for the purposes of promoting, advertising, and archiving The Event. To photograph, audio, or video record my presentation at The Event, including all materials prepared or provided by me (collectively, the Program), for the purposes of keeping good records, to promote and publicize future events, and to make archives available where possible, with the understanding that all products of such activity will be released or sold to the community and the public. To reproduce for webcasting, broadcasting, and live audio or video streaming, I hereby assign Bellevue Breakfast Rotary Club the permission to publish, broadcast, transmit, or otherwise exhibit all or any part of my presentation, to make, and distribute digital recordings for the purposes of keeping good records, to promote and publicize future events, and to make archives available where possible, with the understanding that all products of such activity will be released or sold to the community and the public. The right to engage an authorized agent or provider for the purposes of producing archival materials and distributing same under the direction and guidance of Bellevue Breakfast Rotary Club, with the understanding that all products of such activity will be released or sold to the community and the public. I may request any changes for versions of my name, image, voice, likeness, photograph, biographical information, and Program or the written copy that may be used in connection with same in the exercise of the rights granted above. RELEASE I hereby release and discharge Bellevue Breakfast Rotary Club and its officers, employees, agents, assigns, licensees, and successors from any and all claims, demands, and causes of action that may arise by reason of its exercise of the rights herein including, without limitation, any claims of defamation, invasion of privacy, or infringement of moral rights, rights of publicity or copyright. I warrant that I am either the sole owner of all rights in the Program, or that I am authorized to use or present all parts of the Program, and that it does not infringe the copyright or other property rights of any third party, that it does not contain any defamatory material or any factual inaccuracies except that which is stated as a matter of opinion, and that I have full power to convey the rights granted herein. Should my presentation contain content that is the property right of others, I will inform Bellevue Breakfast Rotary Club as to that content so that it may either be removed or proper copyright may be posted. The grant contained herein does not limit the right of Speaker to make any other use of his or her intellectual property in any other way not inconsistent with the grant contained herein. Bellevue Breakfast Rotary Club is not obligated to utilize any of the rights granted in this Agreement. CONTACT INFORMATION My contact information is as follows: Name First Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Email* Enter Email Confirm Email Signature*SIGNATURE I have read and understood this agreement and I am over the age of 18. This Agreement expresses the complete understanding of the parties. Reset signature Signature locked. Reset to sign again Δ