Asa Copyright License

ASA COPYRIGHT LICENSE

This agreement (“Agreement”) is made between ______, anindividual with a principal business address of ______(“Licensor”), and the American Society of Anesthesiologists, a corporation, with a principal business address of 1061 American Lane, Schaumburg, IL 60173 (“ASA”).

Youhave been requested and/or retained by ASA to create and produce apresentationtitled“______” (“the Work”). You will retain all ownership rights in the content of the Work, including but not limited to the right to use the content of the Workin any form, electronic or otherwise, for other purposes, subject to ASA’s license set forth herein.

NOW THEREFORE, inconsideration of the promises, conditions, covenants and warranties herein, the parties agree as follows. With regard to the Work:

1.You grant ASAa non-exclusive license to use, reproduce, publicly display, distribute,modify, create derivatives to,resell, reprint, or otherwise utilizethe Work, throughout the world, in all languages and in all forms now known or later developed, including but not limited to electronic formats from which the Work can be perceived, reproduced, or otherwise communicated either directly or with aid of a machine or device for the full term of the copyright, and all renewals and extensions thereof throughout the world, with the right to sublicense these rights to third parties. This license is perpetual, irrevocable, and royalty-free.

2.You consent to ASA’s use of your name, likeness, identity, trademarks, and trade symbols, if any, for the purposes of fulfilling this Agreement and in connection with ASA’s use of your Work, including without limitationin its publication(s), website publication(s), and for general promotional purposes.

3.You warrant and represent that:

(a) you have full power and authority, free of any rights of any nature whatsoever by any person, to enter into this Agreement and to grant the rights which are granted to ASA in this Agreement;

(b) no part of the Workinfringes upon any copyright or other intellectual property right of any third party;

(d)you have, as necessary, obtained appropriate permission to re-print any portion of the Workwhich you are not the author.

4.You shall indemnify and hold harmless ASA and its affiliates, and their respective agents, board members, employees, contractors, successors, assignees and licensees from and against any claim, damage, liability, expense or loss, including reasonable attorneys’ fees and costs associated therewith, or with the enforcement of this indemnity, arising from any claim for copyright infringement asserted against ASA by any person or entity arising as a result of ASA’s use of your Work, or arising from your actual or alleged breach of any of your representations and warranties in this Agreement.

5.ASA is not obligated to use or publish the Work in whole or in part and that ASA may in its sole discretion edit the Work for use or publication. In consideration of the rights granted to it pursuant to this Agreement, ASA agrees to fully acknowledge you as the author of the Work.

Name/Title:______

Institution/

Organization:______

Address: ______

______

Phone:______

Email:______

Signature/Date:______

June, 2015