ML18355A843

NRC 1106 Speaker Agreement Form

ML18355A843
Person / Time
Issue date:	12/21/2018
From:	Division of Decommissioning, Uranium Recovery and Waste Programs
To:	Holtec
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ML18355A840	List: ML18355A841 ML18355A842 ML18355A843
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Download: ML18355A843 (2)

Text

NRC FORM 1106 U.S. NUCLEAR REGULATORY COMMISSION (09-2018)

RIC EXTERNAL SPEAKER AGREEMENT FORM Speaker information and slide presentations are included in RIC conference materials and are made available on the public RIC website. Conference materials are available to the general public in advance of the RIC and on site at the facility. Your consent is required for NRC to publish your information in RIC conference materials and on the public RIC website.

• To grant NRC permission, please sign Agreement #1 below.

• If you wish to grant NRC permission in part, please sign Agreement #2 below.

• If you do NOT wish to grant NRC permission to make your information public, please sign Agreement # 3 below.

AGREEMENT #1 (Agree to have all of my information made available to the public).

I accept the invitation to be a speaker at the RIC, and grant NRC permission to:

• Photograph, video record, audio record and post my image, voice, and written information and materials such as my biography and presentation slides on the public RIC website (Internet); and

• Use the aforementioned images in educational and information activities as needed.

I understand and agree that I will not receive specific compensation, now nor in the future, in connection with the NRC's exercise of the rights granted here under.

Typed or Printed Name of Speaker Speaker's Organization Speaker's Signature Date AGREEMENT #2 (Agree to have only the following checked items made available to the public).

I accept the invitation to be a speaker at the RIC, however, the NRC has my permission to make the following checked items available on the public RIC website. (Check only the information to be made public).

Contact information (name, position title, organization (for the program and website).

Biography Presentation Photographs, video recordings Audio recordings I understand that the agency may be required to release such recordings to the public if requested under the Freedom of Information Act.

Typed or Printed Name of Speaker Speaker's Organization Speaker's Signature Date NRC Form 1106 (09-2018) Page 1 of 2

NRC FORM 1106 U.S. NUCLEAR REGULATORY COMMISSION (09-2018)

RIC EXTERNAL SPEAKER AGREEMENT FORM (Continued)

AGREEMENT #3 (Do NOT agree to have any of my information made available to the public).

I accept the invitation to be a speaker at the RIC, but, I do NOT grant NRC permission to make my information public on the RIC website. I will inform my Session Coordinator of my request.

Typed or Printed Name of Speaker Speaker's Organization Speaker's Signature Date Please save form and submit via e-mail to Date Submitted:

RICMST.Resource@nrc.gov (MM/DD/YYYY)

NRC Form 1106 (09-2018) Page 2 of 2