Presenter Registration – Women Emerging Summit

Presenter Intake Form

First Name *

Last Name *

Professional Title

Example: Author, Life Coach, Dr., RN (1-2 words/abbreviations)

Email *

Paypal Email

Your PayPal address where we will send your affiliate commissions

Phone *

Website/URL

Interview Subject Title *

Outcomes/benefits-oriented title

Interview Questions and/or Bullet Points (5-6) *

Name of Free Gift

Free Gift Description

Short Free Gift URL

List Size *

Bio (50-100 words) *

Headshot Photo (JPEG or PNG)

Maximum file size: 5MB

If you have difficulty uploading your photo, email it (clearly identified) to admin@newdreamfoundation.com.

Date for your featured promotional email

The summit is April 17, 2020 through April 21. The promotional period is March 19 through April 15th. (Closer to launch is preferred.)

What are your social media URLs where you will be posting and what dates? *

Will you be creating a short "Standing with You" video? (recommended) *

Yes

This video can include something you have learned you would like to share. (Up to 2 minutes in length)

By what date will you submit your "Standing with You" video? (April 12 latest)

While we prefer a separate hi-quality video, you can specify that you will be doing this as part of your interview video call.

Will you be creating a 15-30 minute instructional video to be included in the Women Emerging Healing Program as part of the affiliate program? (recommended) *

Yes

By what date will you submit your instructional video? (April 3 latest)

While we prefer a separate hi-quality video, you can specify that you will be doing this as part of your interview video call.

Agreement

In signing this, you, the Expert, and Misa Hopkins/New Dream Foundation, are agreeing to the terms as noted below:

General Terms:

✓ You agree to participate as an expert for one video interview.
✓ You agree to participate in a 30-minute pre-recorded video interview.
✓ You agree to 1 promotional email between March 1 – April 15 and sharing the event on social media 3X, as well as commenting on social media posts you’re tagged in so that we can reach as many participants as possible.
✓ Misa Hopkins agrees to provide the back-end coordination and production for this event, including the video interview, interview instructions, email reminders to participants, website, Facebook promo, and promotional copy for your newsletter.

Compensation: You agree to do the interview without charge, and agree not to request compensation from Misa Hopkins and New Dream Foundation at any point in the future.

I hereby grant Misa Hopkins and New Dream Foundation the right to use any photos as well as audio or video impressions of me recorded or provided to me in connection with or as any part of the presentation or promotion of it, in perpetuity. I understand that these impressions, as well as my name, likeness, voice and biographical material, may be used for commercial, educational, and informational purposes, in any manner or media, in the perpetuity, throughout the world.

The material you share on your expert call is, and will remain, solely yours. Misa Hopkins and New Dream Foundation may re-purpose, re-sell, and re-use your recording indefinitely, and without compensation to you. You will be provided with a video recording of your expert interview should you request it. You are free to repurpose, re-sell and re-use your expert call recording indefinitely, and without compensation to Misa Hopkins and New Dream Foundation. In so doing we ask that you identify this as a New Dream Foundation event, and provide a link to our website, https://WomenEmergingSummit.org.

You agree to indemnify, defend and hold Misa Hopkins and New Dream Foundation, harmless from and against all claims, suits, proceedings, losses, costs, liabilities, damages and expenses (including attorneys’ fees) arising out of any claim that your participation in the Conference or any materials or information that you provide during the interview (i) infringes or misappropriates any copyright, trademark, trade secret, patent, right of publicity or other intellectual property right, or (ii) otherwise violates any person’s rights or any law, rule or regulation.

We ask that you fully participate so together as a team we can create a successful event that inspires women around the world. In the event that the commitments listed above are not fulfilled on time, your interview will not be broadcast as part of the interview series.

I consent to having Misa Hopkins and New Dream Foundation collect and store my information via this form for the purpose of my participation in the summit.

Optional: I intend to participate in the affiliate sales program. I understand I will receive a 50% commission on all purchases made by referrals from my unique program url. I understand payment will be received 60 days after New Dream Foundation has received payment from purchasers.

Yes

Signature *

Clear