The Torch Mom Podcast Guest Application

1
Legal Name* This field is required.
First Name
Last Name
2
Nickname
3
Which name would you prefer to be used on the Podcast?
4
E-mail* This field is required.Please keep an eye on your email (and spam folder) after submitting your application, and be sure to read all emails in their entirety.
example@example.com
5
Phone Number* This field is required.Please provide a phone number that you will be available to answer.
Country Code
Area Code
Phone Number
6
City/State* This field is required.
7
Gender* This field is required.
Please Select
Please Select
Female
Male
8
Age Range* This field is required.
Please Select
Please Select
18-24
24-35
35-45
45-55
55+
9
Instagram, Facebook & TikTok Handle* This field is required.If you don’t have all three, that’s perfectly fine! Just list the one(s) you do have.
10
Have you ever been interviewed on a podcast? * This field is required.
Please Select
Please Select
Yes
No
11
What category best describes you? * This field is required.
Please Select
Please Select
Influencer
Entrepreneur
Stay At Home Mom
Working Mom
Model
Artist
Comedian
Chef
Other
12
Are you comfortable with being transparent on sharing your experiences and about becoming/being a mom? * This field is required.
Please Select
Please Select
Yes
No
13
Our podcast occasionally covers topics related to personal intimacy. Would you feel comfortable discussing your experiences or insights in this area, or would you prefer to focus solely on other aspects of your expertise?
I’m comfortable
Focus on other aspects
14
Bio or Intro about yourself & business * This field is required.
15
Share something different and fun that sets you apart and makes you an interesting guest for The Torch Mom Podcast* This field is required.
16
Choose your feature date* This field is required.Wednesdays ONLY
Date
Month
Day
Year
17
What time works best for you* This field is required.on the Wednesday you chose above
9:15pm-10:00pm EST
10:20pm-11:05pm EST
18
Relationship Status* This field is required.
Single
Engaged
Married
Divorced
19
If married, how long
Less than 1 year
1-4 years
5 years
5-10 years
10+ years
20
Select which applies* This field is required.
Parent
Single Parent
Mom after 35
Epidural
No Epidural
C-section
Used IVF
Midwife or Home Birth
21
By checking the following box below confirms that you accept and consent to the following terms and conditions:* This field is required.
I authorize and grant permission to The Torch Mom Podcast, the released parties, their agents, representatives, and others working under their authority. To take and use my photographed, video recorded, live-streamed image, likeness, voice, and name for any and all purposes. Which includes marketing, commercial and advertising purposes in any and all forms of media without reservation or limitation. I understand and agree that I have no rights to any benefits derived from the use of such image, likeness, voice, or name.
22
Signature* This field is required.
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