Co-Speaker Consent and License for

Presentation/Materials

Residency Leadership Summit

Name:	Click here to enter name.
AAFP ID #:	Click here to enter AAFP ID.
Workshop # & Title(s):	Click here to enter Workshop # and Title(s).
Workshop Date(s) & Time(s)	Click here to enter Date(s) and Time(s).
Primary Speaker Last Name:	Click here to enter Primary Speaker last name.

Speaker’s Ownership and Use. I will prepare certain materials (the “Materials”) for use and distribution for the workshop presentation(s) set forth above at the American Academy of Family Physicians’ (the “AAFP”) Residency Leadership Summit (the “Summit”), which will take place in Dallas, Texas from March 4-6, 2026. I will be the sole owner of any such Materials developed, submitted and/or used in connection with the Summit. I represent and warrant (a) that the Materials are factually accurate and contain no libelous or otherwise unlawful statements; (b) that I am the sole author and owner of the Materials and/or have obtained the right to use and license the Materials as contemplated hereunder; and (c) that such use and license will not violate the proprietary or personal rights of any third party (including, without limitation, copyrights, trademarks or privacy rights).

Speaker’s Grant of Rights to the AAFP. I grant to the AAFP and its designees the following rights and licenses on a non-exclusive, irrevocable, worldwide, sub-licensable basis:

The right to use my name, likeness, image, photograph and biographical data in connection with the promotion and distribution of the presentation and/or Materials and any AAFP activities related thereto;

The right to have my presentation and/or Materials presented by other speakers if I am unable to attend the Summit due to illness, death of a family member, or as determined by the AAFP;

The right to include all or part of the presentation and/or Materials in presentation slides, handouts and other Summit materials, which are made available in any form or format, including, without limitation, print, current and future electronic media, and the Internet (collectively, “Format”), and the right to revise any such Materials as deemed appropriate for such inclusion;

The right to record my presentation and/or Materials on audio/video and to reproduce, distribute, live stream, sell and otherwise make available transcripts, copies, on-demand products and/or recordings of the same, in whole or in part, for any lawful purpose and in any Format; and

The right to make derivatives of all or part of the presentation and/or Materials and to include the same in reprints, anthologies, translations and any other AAFP products or publications.

I represent and warrant that the AAFP’s exercise of any such rights will not violate the rights of any third party. This Consent and License for Presentation/Materials will survive after completion of the Summit.

I (i) acknowledge that I have completed the AAFP’s CME Disclosure Form prior to signing this document and (ii) agree that I have a continuing obligation to update my CME Disclosure Form as changes to my relationships occur. If there is a change, I agree to promptly submit notification of update of my CME Disclosure Form to the AAFP.

Signature:	Type name here to sign.	Date:	Click to enter date.

(Electronic signature is acceptable and binding)

Please email this completed form by Day/Date, 2025 to rls@aafp.org.