Language
English (US)
Español
Spanish (Latin America)
HUG Podcast Network Guest Survey
HUG Podcast Network Guest Survey Form
If you watched the video above, we requested a 150-word bio. Use this form to give us the information we need and we'll write your bio for you. Please answer the following questions to help us create a script for our program. Please fill out a separate form for each program for which you wish to be a Guest (for example, Heart to Heart with Anna or Bereaved But Still Me, you will need to fill out a form for each show.
Name
*
First Name
Last Name
Email
*
example@example.com
Home Phone: Please include area code and country code if outside the USA
*
Please enter a valid phone number.
Mobile Phone: Please include area code and country code if outside the USA
*
Please enter a valid phone number.
Back
Next
Save
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 your CHD's and surgeries (if applicable)
*
Please tell us about yourself and why you would be the perfect guest to be on our show, also how you are an expert on the topic you've chosen. We would like to have this in about 150 words and include the name of your/your child's) heart defect, your age, surgeries you've had, etc. If you wish to talk about a dearly departed, please do so here for the Bereaved Podcast with Michael.
*
Any other pertinent information (if you are a parent, name and ages of other children; if you are an ACHDer, your heart condition right now, especially if on the transplant list or just recently had surgery; if you are a professional, please let me know what hospital with and any professional information that is pertinent to the show)
*
Tell us about your availability to record the program when you will be in a quiet setting, preferably alone (please be specific)
*
Do you have, or are you willing, to put Skype on your computer or smart phone? (This is a free app)
*
Yes I already have Skype
No, but I am willing to download on my phone or computer
No
Maybe
Please check all equipment you have available:
*
Headset with a mic
Earbuds with a mic
Headset with an external mic
Smartphone with Skype availability
Telephone
Other
Are you interested in volunteering for Hearts Unite the Globe?
Yes
No
Maybe
Save
Submit
Should be Empty:
Now create your own Jotform - It's free!
Create your own Jotform