Podcast Guest Intake Form
We're thrilled you want to be on our show! Complete the form below and we'll be in touch shortly.
Name
*
First Name
Last Name
Please write the phonetic pronunciation of your full name
*
Organization
Phone Number
*
-
Area Code
Phone Number
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
E-mail
*
example@example.com
Newsletter
Yes, subscribe me to the newsletter.
Personal Website
LinkedIn
Instagram
Facebook
Twitter
Pinterest
YouTube / Other
TikTok / Other
Your bio in 2-3 sentences
*
Why do you want to be on The Mediacasters? What story are you working to tell?
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Provide 2 tips or tools you'd like to share with our audience that can help elevate their voices and improve their impact
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Please share any links to past speaking engagements
Type "YES" below to acknowledge that you understand any recorded content is the property of The Mediacasters and may be used in promotion of the show. While each show is edited, final edit shall be at the discretion of The Mediacasters and copyright remains that of The Mediacasters
*
Cross-promotion for greater impact
Yes, I agree to promote the podcast we record together on social media, in an email to my community, and on my website as applicable.
Please provide at least one high-resolution headshot to utilize in the podcast promotional materials. Be sure to include your logo and book image as applicable (multiple files are allowed)
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How did you hear about us?
Google Search
Referred by someone
I'm a listener
Instagram
Clubhouse
Anything you want to add?
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