Congratulations, you have been selected as a finalist at the Women in Tech® Regional Awards.
We Kindly ask you to please fill in this form at your earliest convenience. This information will be sed for the final judging as well as event ceremony brochure.

  • This will be the official title used in all communication.
  • This will be the official copy used in all presentation, including the Award's printed brochure.
    I hereby AUTHORIZE the use of my image and voice to be used in any type of media by Women in Tech®. and its affiliates, employees, and agents (“WIT”), to be disclosed to the public in general and/or only for internal use, provided that there is no deviation from its purpose. 1. The broadcasting will be based on videos, photos, images and audios captured with my consent. 2. I declare that I am aware that the materials produced will remain in circulation, and it is not possible to determine for how long my image may be reproduced by physical and virtual means, which may occur through third parties unrelated to Women in Tech®, which may be occur beyond Women in Tech®`s control and/or without authorization of Women in Tech® and its affiliates. 3. This authorization is granted free of charge, covering the use of the above mentioned image in the production and circulation of materials throughout the national and international territory, in all its modalities, highlighting its use in the following ways: social networks and digital platforms, outdoor; flyers in general (inserts, direct mail, catalogs, etc); advertisements in magazines and newspapers in general; home page, electronic media (billboards, video-tapes, television, cinema, radio programs, among others). And for being in full agreement with all the conditions herein agreed upon, I declare that I authorize the use of my image described above, without any claim for rights to my image or any other title, arising directly or indirectly from this authorization.

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