SPEAKER RELEASE FORM

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I grant the Northern Blue Ridge Overeaters Anonymous Intergroup, heretofore known as “NBROAIG," the perpetual right to use recordings of my voice in connection with NBROAIG meetings, workshops and other NBROAIG events in any legitimate manner at the discretion of NBROAIG and/or Overeaters Anonymous, Inc.

This includes the right to use my first name, last initial and to classify the recording using the selected identification categories. I relinquish all rights, title, and interest I have in the recordings of meetings, workshops, and other NBROAIG events made hereunder, or any reproductions made of such recordings.

Email *

Full Name *

Phone Number *

Speaker Signature
*

By checking this box you authorize that this is your legal electronic signature.

Required

Date Signed *

YYYY

Identification categories are implemented by OA World Service. These help viewers identify topics they may be interested in listening to. *

Anorexic

Bulimic

Overeater

100 Pounder

Over Exerciser

Young (<35)

LGBTQAI

Black

Latinx

Asian

Española

Other

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