9th Annual Kick Sugar Summit 2023 [Speaker Application and Agreement Form]

Welcome, Valued Speaker,

Thank you for your interest in participating in our upcoming 9th Annual Kick Sugar Summit. 

It is our pleasure to profile and promote the work of sugar educators, scientists, authors, doctors, celebrities, and coaches. 

Our mission is to share the science and strategies individuals need to reduce or eliminate their consumption of sugar and refined carbohydrates, which we know are directly linked to diabetes, obesity, depression, dementia, heart disease, and even cancer.

Below is an application form that we need you to complete in full, please and thank you.

Please be aware that your interview may be used on our summit, podcast, and/or YouTube channel. We will inform you as to which platforms your interview will appear on.

If you have any questions, email us at

Thank you, 

Florence Christophers
Founder and Host, Kick Sugar Summit

P.S. - If you are already confirmed as a speaker (or have completed your interview), you are receiving this because we still require the information on this form. Thank you.



(First name, Last name)




Paypal E-mail



(Street Address, City, State, Zip Code, Country)




Phone Number


Assistant Name (if applicable)


Assistant E-mail (if applicable)


Short Professional Biography


Professional Headshot (High Resolution Image)

We'll be using the image for promoting your interview


Please Provide Us with a Suggested Title for Your Interview


Please Share 4-5 Questions You Would Like to be Asked During Your Interview

  1. ×
Add item

Is there a Specific Product/Service/Event You'd Like to Promote During the Interview?

E.g. a new book or product launch, campaign, celebration, etc. (if none, say N/A)



All speakers are welcome to offer a free gift that will be included as part of our digital speaker packages that can be purchased by participants. 

Offering a free gift to our audience benefits speakers in three ways:

  • It will be added to digital speaker packages as a bonus. This adds value to the package and incents sales. This, in turn, boosts affiliate revenue.

  • Offering a free gift that requires participants to go to your landing page and opt-in to redeem will help drive summit traffic back to you. In other words, it helps you grow your email list.

  • It helps you stand out from the other speakers.

Note: We reserve the right to refuse gifts we feel are not aligned with our audience or our values.


Title of Your Free Gift


Description of Your Free Gift


Exact URL to Claim Your Free Gift



If you have an email list and social media following, we ask that you help us promote your interview. If you do not, the following questions do not apply to you.


What Date Do You Plan to Send Out a Solo Email to Your List?



Solo Email Follow-Up Date to 'Unopens'



Social Media Post #1



Social Media Post #2




9th Annual Kick Sugar Summit

Summit Date:  October 16-23, 2023

We ask that speakers participate and help promote the 9th Annual Kick Sugar Summit 2023 according to the following terms.

General Terms:

  • I agree to provide a 45-60 minute pre-recorded video interview that will air live during the Kick Sugar Summit 2023 free of charge to all summit participants.

  • I agree to do the interview without payment and agree not to request compensation from Florence Christophers or the Kick Sugar Summit at any point in the future.

  • I acknowledge that digital copies of all Kick Sugar Summit 2023 interviews will be available for purchase before, during, and after the summit. 

  • I understand I have the opportunity to sign up as an affiliate of the summit.

  • I understand that as an affiliate, I will earn 50% of all sales earned through my affiliate link, which will be paid out in full 30 days after the summit ends (and the refund period has closed). 

  • If you have an email list and/or social media following, I agree to promote the summit according to the following terms.

Promotion Commitment:

I agree to promote the Kick Sugar Summit 2023 as follows within our promotional period of October 1-16, 2023. This is our minimum request:

  • (1) solo email to my email list
  • (1) follow-up email to the unopened emails
  • (2) Social Media posts 

Other options include:

  • Newsletter shout out
  • An article in a magazine or trade publication
  • Twitter
  • Instagram
  • Tiktok
  • YouTube
  • Facebook Live
  • Media interview

We acknowledge and understand that some of our medical experts and doctors do not have lists or social media channels and cannot promote.

The Kick Sugar Summit Commitment (Our Commitment to You):

We agree to provide:

  • An affiliate link prior to the promotion window
  • Swipe copy (suggested copy you can use to promote the summit)
  • Personalized Facebook ads 
  • Hands-on support with all aspects of your promotions
  • To pay you within 30 days of the summit ending (and the refund period has closed)
  • An opportunity to talk about your book, products, and services during the interview

NOTE: KSS reserves the right to NOT include any completed summit interview for any reason we deem fit. This could include the content or information that was not relevant, the sound or visual quality was poor, we felt it would be better included as part of the bonus package, etc. We may also choose to use your interview for our podcast / Youtube Channel instead. This decision will be communicated to you in advance of the summit airing.

I have read and agree to the Kick Sugar Summit 2023 promotional terms as stated above.



This release allows you to legally participate in the 9th Annual Kick Sugar Summit 2023 and for us to record, own, share and sell your interview via our Kick Sugar Summit.

  • I hereby acknowledge that my participation in the Kick Sugar Summit as a Speaker will include a video and/or audio interview as part of the 9th Annual Kick Sugar Summit 2023.

  • I understand that for educational and commercial purposes, this interview will be recorded and shared during the summit at no cost to attendees.

  • I hereby grant to the Kick Sugar Summit (Florence Christophers) the right to use my name, voice, appearance, likeness, image, words, participation, photos, and title or professional designation, in whole or part, (now collectively referred to as “recordings”) in any correspondence, podcast, YouTube channel, publicity, advertising, promotional, or other derivative materials based on them.

  • I hereby grant the Kick Sugar Summit (Florence Christophers) the unconditional and irrevocable right to reproduce the recordings in any format, and to distribute, sell, advertise, and publicize the recordings without compensation.

  • The Kick Sugar Summit may edit the recordings as needed to improve their quality.

  • I understand that the Kick Sugar Summit (Florence Christophers) shall own the worldwide rights, title, and interest, including copyright in, and to, the recording.

  • I acknowledge that I shall also retain the same rights and may use the recording (my interview) as I see fit. 

  • I understand that a digital/electronic copy of the recording will be made available upon written request.

  • I agree to assist with promoting the Kick Sugar Summit by sending a minimum of 1 (one) solo email to my entire database during the agreed-upon promotion period. I also agree to send 1 (one) follow-up email to the unopened recipients. I also agree to promote twice on all available social media outlets during the promotional period (two weeks prior to the event). These include newsletter paragraphs, Twitter, Instagram, Facebook posts or AD, blog posts, media interviews, Facebook Lives, Instagram Stories, etc.

  • I understand I am able to make a FREE offer during my presentation/interview including the provision of a URL or other traffic destination.

  • I affirm that I am over the age of majority and have the full right, power, and authority to grant this release and to perform all of the provisions thereof. 

  • I acknowledge that in the event of a breach or alleged breach with respect to the terms and provisions hereof, the Kick Sugar Summit (Florence Christophers) shall be entitled to such injunctive or equitable relief as Florence Christophers may deem appropriate, in addition to such other rights or remedies Florence Christophers may have at law. 

  • I agree to indemnify and hold harmless the Kick Sugar Summit (Florence Christophers) from and against all claims, losses, expenses, and liabilities of every kind including reasonable attorney’s fees arising out of the inaccuracy or breach of any provision of this Agreement.

  • I expressly release the Kick Sugar Summit (Florence Christophers) from any and all claims arising out of the use of the material.

  • This release shall be governed by law, constitutes the entire agreement of the parties, and may be amended only in writing.

I have read the foregoing and understand the meaning and effect thereof. I intend to be legally bound.





Do You Have Any Questions for Us?