Speaker Information Form

Thank you for agreeing to speak at Ecosystem 2.0, the IAB Annual Meeting. You are part of a distinguished roster of speakers whom we are confident will be well received.

Please take a moment to complete and submit this form in its entirety by January 16. Once submitted, your registration for the conference will be complete and you will receive confirmation of your complimentary pass via email.

Lisa Milgram
Director, Events
(212) 380-4733
Interactive Advertising Bureau

All fields with an asterisk (*) are required.

Contact Information
First Name* 
Middle Initial 
Last Name* 
Address 1* 
Address 2 
Zip Code 
Email Address* 
Assistant / Secondary Contact Name 
Assistant / Secondary Contact Email 
Assistant / Secondary Contact Phone 

Biography & Headshot 
Please provide us with an annotated professional biography (150 words max) as well as a recent headshot. These will be used in the documentation book that all attendees receive as well as on the event website. You can copy and paste the annotated biography and upload the headshot below. 
Please copy and paste your annotated professional biography (max 1500 characters or 150 words) 
1500 characters remaining
(Word .doc only. 10 MB max file size limit)
Please upload your headshot 
(jpeg, gif, or tiff only. 10 MB max file size limit)

NOTE: 10 MB max file size limit on all uploads. If the filesize of any item is greater, please contact [email protected] to make special arrangements.

Contact Preferences 
Please select your contact preference* 
  Please use my assistant / secondary contact for all further communications.
Please copy my assistant / secondary contact on all further communications.
Please use my assistant / secondary contact as the primary recipient for further communications and copy me.
Please let us know if you have any special requirements or questions 

Speaker Release Form
As part of the conference educational materials and as a service to participants, audio and video recordings of all presentations at the conference and written or electronic materials that I deliver for the conference may be made available to conference participants during and after the conference, and may further be available for sale to the general public.

I hereby grant to the IAB the absolute right and permission to use, copy and distribute in perpetuity my name and likeness, the recordings of the conference and the materials that I deliver for the conference, either alone or accompanied by other material, in any manner, throughout the world, for any lawful purpose whatsoever, in any media now known or ever developed. I hereby waive all my rights to inspect and approve the finished product, its use or such written or spoken copy as may be used in connection therewith.

I agree that I will not hold the IAB, or anyone who receives permission from the IAB, responsible for any liability resulting from the use of my name, likeness and/or materials in accordance with the terms hereof, including what might be deemed to be misrepresentation of me, my character or my person due to distortion, optical illusion or faulty reproduction which may occur in the finished product.

This release form in no way inhibits me from using my own materials in any manner I so desire.

This release will insure to the benefit of the IAB, affiliates, successors and assigns.

Please select one*  I agree to the above terms of this release agreement
I DO NOT agree to the above terms of this release agreement