BreakThrough IBA Audio Release Form Leave this field blank I, the undersigned student, in (required) taught by (required) and being held online on (required) (just give Month & Year if you do not know exact dates) request permission to audio record the material presented during the seminar while also agreeing that I will NOT video record the seminar. (optional) In being permitted to audio record the material: (optional) I agree that this audio recording shall be used solely for the purposes of individual private study by only the undersigned, and that the recording(s) shall not be sold, shared, transferred, re-recorded, or published in any way. I agree to save the recordings to a separate thumb drive or external hard drive and will not store them on my local computer where they are not secure. I agree to destroy the recordings when they are no longer needed for purposes of my private study. I agree that I am responsible for all costs associated with making the audio recording(s). I acknowledge that abuse of the privilege to make audio recordings of the course material constitutes a violation of the IBA’s policies, as well as a violation of international guidelines that respect student confidentiality and privacy. I acknowledge that such violations will, at a minimum, result in the loss of such privileges in the future with any IBA Instructor, and may involve legal action. Date: (required) Month January February March April May June July August September October November December Nothing found Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Nothing found Year 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033 2034 2035 2036 2037 2038 2039 2040 2041 Nothing found Signiture (required) I agree that my typed name below will be as valid as a handwritten signature to the extent allowed by local & international law Instructor: Terryann Nikides (optional) I the Instructor for the above-named IBA seminar, hereby do not object to the above-named student making audio recordings of the lecture or practical material in the course, for the purpose of private study, under the conditions set forth above. (optional) As dated above. Note: Instructor shall keep this record on file for IBA reference as needed.