Please enable JavaScript in your browser to complete this form.Name *FirstLastEmail *Phone *AddressCity, State ZipAre you willing to share your session's PPT/Handouts with participants?YesNoWhat is your proposed Session Title? *What would you propose as a two-sentence description of your presentation to include in the Forum Program Booklet?Additional Comments In consideration of the opportunity to appear on an audio/videotape depicting various aspects of the presentations and activities of the 2022 USA/Canada Lions Leadership Forum, the undersigned hereby waives any and all rights and interests in said audio/videotapes, relinquishing said rights to the 2022 USA/Canada Lions Leadership Forum, including, but not limited to, the right to receive any and all proceeds derived from the sale of said tapes for educational and promotional purposes. ELECTRONIC SIGNATURE: *Clear SignatureIMPORTANT NOTICE: Typing your name in the box above will constitute your electronic signature.Date / Time *DateTimeSubmit
