Guest Intake Form
Name
First Name
Last Name
Title/Role
Phone Number
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Area Code
Phone Number
E-mail
Organization (if any)
Bio
Topics you are excited to talk about?
Have you been interviewed on another show/podcast?
Yes
No
If yes, please provide URLs of podcasts or interviews if available.
Talking Points - Minimum 3
Do you own proper equipment for streaming? (headset, microphone, computer, decent internet?)
Yes
No
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LinkedIn Profile
YouTube Chanel
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One Sheet/Additional Information
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Anything else we should know?
For consideration which I acknowledge, I consent to the recording of my statements and grant to Protector's Toolkit and the Host's assigns, licensees, and successors the right to copy, reproduce, and use all or a portion of the statements (the “Interview”) for incorporation in the Warrior Wednesday Show or A Word & A Weapon Podcast (the “Podcast/Show”). I permit the use of all or a portion of the Interview in the Podcast/Show in all forms and media including advertising and related promotion throughout the world and in perpetuity. I grant the right to use my image and name in connection with all uses of the Interview and waive the right to inspect or approve use of my Interview as incorporated in the Podcast/Show. I release the Host and the Host's assigns, licensees, and successors from any claims that may arise regarding the use of the Interview including any claims of defamation, invasion of privacy, or infringement of moral rights, rights of publicity, or copyright. I acknowledge that I have no ownership rights in the Podcast/Show. The Host is not obligated to utilize the rights granted in this Agreement. I have read and understood this agreement and I am over the age of 18. This Agreement expresses the complete understanding of the parties.
I agree
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