Tribalize IV Summit Speaker Intake Form May 14-16, 2021 Tribalize IV Presenter Intake Form About YouName* First Last Cell Phone*Email* Website* Your Bio (100-250 words)*Upload Your Best High Res Headshot*Max. file size: 500 MB.Assistant Contact Info (If Applicable)Your Assistant or Contact Person's Name First Last Your Assistant or Contact Person's Email Your Assistant or Contact Person's PhoneYour PresentationContent* Talk Class / Workshop Facilitation Ceremony / Ritual Interview Musical Performance Regenerative Living Civilization Design Indigenous Wisdom / Living Culture Community Spotlight Other Please check all that apply. Thanks!If other, please describe belowPresentation Title* If you are on a panel, please simply write "panelist"Presentation Description*Please keep it to the maximum 100 words. If you are on a panel, please simply write "panelist"Are you doing a Live or Virtual Presentation? Virtual Online Live in Tulum Both What type of technology will you need for your presentation? Sound Musical Sound Video Projection Other If other, please describe belowDays / Times Available*Are there any days or times that you are NOT available during May 14 - 16, 2021 to be scheduled for the Summit?AgreementsPromotions* Yes, I will promote Tribalize Virtual Summit No, I will not be able to promote the Tribalize Virtual Summit Tribalize will naturally promote you and your work before, during and after the Summit in a variety of ways. Please let us know if you will share the summit with your audience.Accommodations* I can pay for my own accommodations to support Tribalize I need assistance with my accommodations in order to participate live Not necessary, I can only participate virtually Please let us know your status re: accommodations. Thank you.Travel Expenses* I will handle my own travel and other expenses I cannot handle my own travel and other expenses Not necessary, I can only participate virtually We are able to cover a number of your meals. You will be responsible for your travel to Tulum and any auxiliary expenses. Please also respond to the question around your accommodations needs.Tribalize LLC Media Agreement* I AGREE to the Tribalize LLC Media Agreement I DO NOT AGREE to the Tribalize LLC Media Agreement I have questions about the Tribalize LLC Media Agreement I hereby authorize Tribalize LLC to record my likeness in the form of audio, video and photographs during my presentation at TRIBALIZE IV in Tulum either live in-person or virtually (depending on whether I am appearing live or virtually). I understand that TRIBALIZE LLC will allow ticket holders to view the replays as well as allowing ticket holders to watch the live presentation. Further, I understand Tribalize LLC may elect to utilize my photographs, audio or video in promoting upcoming summits. Tribalize LLC shall not modify my presentation but will keep it in-tact as presented in video representations. The only exception to this may be if a short snippet of it is chosen to be used in a trailer or other promotional piece.CommentsThis field is for validation purposes and should be left unchanged.