New Mexico Living Recorded Guest Appearance Form
Please Note: In order to submit this form, several fields are required including: an image, guest names, topic, talking points, promotion, dates. Please be sure you have all information ready before you begin as the form needs to be complete in full before submission.
Release / Acknowledgment
To the extent I perform any music, read any literary pieces and/or submit any photographs, audio, video or other artistic works to the Station, whether original or otherwise, I hereby represent and warrant that I own, control or have obtained all rights (including all copyrights) in and to all such materials (“Materials”) and I hereby grant the Station, without charge, the rights necessary to use all such materials in connection with the Program in any and all media now known or hereafter devised for any purpose throughout the universe in perpetuity. This also allows the Station to post video from the Program to KRQE's YouTube. I further confirm that the Station’s use of the Materials will not infringe upon the rights of any person or entity. You are also responsible for everything you say while on the program. We are not responsible for any derogatory, defaming, or libel statement you make while on our show.
Agreement
*
Yes, I have read and agree with the terms outlined in the Release Acknowledgment
Do you give New Mexico Living authorization to use photographs from your website?
Yes
No
Appearance Type
Please Select
I'm appearing for a regular segment
I'm appearing for a cooking segment
I'm appearing for a music segment
Your Account Rep
*
Please Select
Alexis Trevino
Beverlie Frazier
Carol Ann Sandoval
Carolyn Rush
Chanel Toppino
Chrystal Bedoe
Dennis Martinez
Eric Lucero
Henry Hoang
Karen Martinez
Faith Crowe
Frank Montoya
Maria Bryan
Marilyn Painter
Michael Martin
Michelle Duran
Nicole Beserra
Naydeen Dajani
Roberta Barajas
Rebecca Cook
Ronn Weese
Trevel Holloway
Appearance
Date the interview will be recorded
-
Month
-
Day
Year
Date
What type of recording
*
ZOOM
Satellite
On Location
Musical Performance
For Specific Location please add where interview will take place
*
Must Air Date: MM/DD/YYYY
Name of Business/Organization/Artist Name appearing on the show
*
Primary Contact Name
*
First Name
Last Name
Primary Contact Email
*
example@example.com
Is Primary Contact listed above also going to be interviewed?
*
Yes
No
Phone Number
*
Website or Social Media URL
*
Tell us about your business, organization, artist:
*
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Appearance Information
Topic of Interview
*
Guest 1 Name
*
First Name
Last Name
Guest 1 Title
*
Guest 2 Name
First Name
Last Name
Guest 2 Title
3-5 Questions or Talking Points you'd like to discuss
*
Cooking Segment Ingredients
Cooking Segment Recipe
Number of Band Members & Names
Name of *Original Music* performing and instruments playing
Upload Files
Browse Files
Drag and drop files here
Choose a file
Please upload photos, videos, or graphics for your segment
Cancel
of
Submit
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