D50 Speaker's Video and Media Release Authorization

SPEAKER’S AUTHORIZATION

FOR VIDEO RECORDING AND/OR SOCIAL MEDIA RELEASE
District 50 Toastmasters

Authorization to be filmed during contest presentation & to have contestant's name listed on District 50 website

Recorded: By checking the appropriate box below, I am either agreeing to be video taped during my competition presentation or requesting that I not be video taped. I understand that I must provide my own videographer and equipment. I also understand that, if I am competing, in the District International Speech contest I will be video recorded.

Social Media: By checking the appropriate box below, I am either agreeing to allow my name to be posted on the district website or social media, or not allowing my name to be posted on the district website or social media, should I place [either 1st, 2nd or 3rd (when applicable)] in the specified contest on the specified date.
Video Recording Authorization: By selecting Yes, I am agreeing to be video taped during my competition presentation. I understand that I must provide my own videographer and equipment. I also understand that, if I am competing, in the District International Speech contest I will be video recorded.*

Yes (I agree)No
Social Media Release: By selecting Yes, I am agreeing to allow my name to be posted on the district website and/or social media, should I place [either 1st, 2nd or 3rd (when applicable)] in the specified contest on the specified date.*

Yes (I agree)No
Contest(s) To Which This Authorization Applies

HumorousTall TalesInternationalEvaluationTable Topics®
Contest Date Authorization*

MonthDayYear
Date
Authorization Signature*

Clear
Authorization Full Name*
Contest Chair Name*
Contest Chair Email*
example@example.com
Should be Empty:

SPEAKER’S AUTHORIZATION