Media Circus Podcast Guest Form

Name

First Name

Last Name

Email* This field is required.

example@example.com

WHICH BEST DESCRIBES YOU* This field is required.Choose as many as applicable

Freelance Journalist

Contributing Writer

TV Producer

Reporter

Blogger

Magazine Editor

Podcast Host

YouTube Host

News Writer

Other

MEDIA OUTLETS* This field is required.Please indicate which are current and former media outlets or brands you've worked for or created content for.

WEBSITE URL* This field is required.The best place for me to gather the most information about you.

YOUR NAME, CREDENTIALS, MEDIA TITLE* This field is required.How you want your name and title to appear in marketing. (Ex: Taiisha Bradley, MA, Celebrity Publicist)

PREFERRED PRONOUNS

She/Her/Hers

He/Him/His

They/Them/Theirs

BIOGRAPHY* This field is required.A brief bio or summary of your expertise and qualifications as a media professional.

BRAND PHOTOS* This field is required.To help promote your episode, please submit a headshot or lifestyle photo that I am authorized to use to promote your episode

Drag and drop files here

Select files to upload

Phone Number* This field is required.Where you may be reached if we experience technical issues.

Please enter a valid phone number.

GUEST RELEASE FORMThe Guest consents to the recording and distribution of reproduction(s) of the Guest's voice and performance as part of the program entitled Off the Press with Taiisha. The Guest acknowledges that Taiisha Bradley, MA (“Podcaster”) is the sole owner of all rights in and to the Program, and that Podcaster has the unfettered right 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. The Guest understands and agrees that he/she shall receive no compensation for appearances on and participation in the Program, and that his/her name and likeness may be used in advertising and promotional material for the Program, but not as an endorsement of any product or service. The Guest releases and discharges Podcaster 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.

Media Circus Podcast Guest Form