Guest Pre-Interview Form

Name *

First Name Last Name

Email *

example@example.com

Phone Number *

Which program would you like to be a guest on? *

Heart to Heart with Anna: A podcast for the CHD Community Bereaved But Still Me: A podcast for the Bereaved Community Guerreros del Corazon

Please tell us about your role in the congenital heart defect (CHD) or bereaved community (parent, grandparent,heart warrior, doctor,nurse, etc.) *

Tell us about you or your loved one's CHDs and surgeries (if applicable)

We need some information to put together a script for you. Tell us about yourself/your child/dearly departed to help us write a meaningful script for you. This information will be used to write a 150-word bio for you and the questions we will ask you in the interview. Please be concise but give us information to share with our Listeners so they are excited to hear our conversation. Specify what topic you would like to address during the program. *

Any other pertinent information? Heart parents/grandparents-don't forget the names and ages of your other children. Adults with CHDs-let us know how you are now or anything else important in this interview. Professionals-please let us know the hospitals you are affiliated with (or if you prefer not to mention that in the interview), as well as any nonprofit or professional organizations that are important for our Listeners to know about you. Bereaved applicants, is there something else we should know about you or your loved one?

Please click all equipment you have available to use during your recording/interview for example Headset with a mic, Earbuds with a mic, Headset with an external mic, WhatsApp, Telephone and/or other equipment.

Headset with Mic Earbuds with Mic Headset with External Mic WhatsApp Telephone Other

Please list any and all websites, social media handles, and any other information we should include in the Show Notes for our Listeners to be able to contact you after listening to the program.

Please attach photos for us to use in promoting your episode. We need at least one head-shot, and at least one photo that is portrait in presentation and one that is landscape in presentation. The more photos you share, the more options we will have for our social media efforts - 8 to 12 photos is best.

Thank you so much for filling out this form to be a Guest on our program. We will contact you either for a pre-interview or with a proposed script. After that, we'll send you our booking link (we use Book Like a Boss) and before you know it, we'll be recording our episode. We are looking forward to our conversation with you.

TERMS and CONDITIONS

I acknowledge that Hearts Unite the Globe (HUG) is the sole owner of all rights in and to the Program, and the recording(s) thereof, as “works made for hire” pursuant to 17 USC §101, et.seq., for all purposes; and that HUG has the unfettered right, among other things, to use, exploit and distribute the Program, and Guest’s performance as embodied therein in any and all media or formats, throughout the world, in perpetuity. Any materials relating to the production and distribution of the Program (“Materials”) become the property of HUG and HUG shall have the sole and exclusive right to use, exploit and distribute such Materials, throughout the world, in perpetuity. Nothing contained in this Podcast Guest Release shall be construed to obligate HUG to use or exploit any of the rights granted or acquired by HUG, or to make, sell, license, distribute, or otherwise exploit the Program or Materials whatsoever. I understand and agree that I shall receive no compensation for appearances on and participation in the Program. My name and likeness may be used in advertising and promotional material for the Program, but not as an endorsement of any product or service. I hereby release and discharge HUG from any and all liability arising out of or in connection with the making, producing, reproducing, processing, exhibiting, distributing, publishing, transmitting by any means, or otherwise using the above-mentioned production.

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Guest Pre-Interview Form

Guest Pre-Interview Form

Podcast Guest Release Form