22nd Annual Speaker Agreement, Disclosures, and Release Authorization « ISCTM | The International Society for CNS Clinical Trials and Methodology

22nd Annual Speaker Agreement, Disclosures, and Release Authorization

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Email Address*
Last Name*
First Name*
Degree(s) or Designation(s)*
Phone*
Assistant's Name
Assistant's Email
Release Authorization Request: To disseminate information of value to the field, ISCTM posts slide presentations and session presentation videos on the ISCTM website. Your cooperation in providing consent to post these slide presentations and videos on the website will be greatly appreciated. Note: all panel/audience discussion segments are posted.
Confirmation and Agreement*
- I agree to present in person at the Mayflower Hotel, 18-20 February 2026, Washington DC.
Presentation Release Authorization*
- Yes, ISCTM may include my presentation on its website.
- No, ISCTM may not include my presentation on its website.
Video Release Authorization*
- I release the video recordings of my presentation for posting only to the ISCTM website.
- I do not release video recordings of my presentation.
Disclosures: Please list all applicable, including grants, honoraria, shares, paid positions, advisory boards, other*
Disclosure Slide*
- I understand that I am required to provide these disclosures as part of my ISCTM slide presentation (on title slide or 2nd slide).
Session in Which Presentation Appears*