C2C Guest Application Form

Thank you for your interest in our show!

Before you begin, please note you will be asked to upload the following: 2-3 photos of yourself with your face clearly visible, and a link to a 3-4 minute video introducing yourself and a bit about your story and why you'd like to be on the show. Also a reminder that this is not a form for nominations. You can suggest guests over on IG @cultstoconsciouness or at patreon.com/cultstoconsciousness Thank you so much!
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Shelise or Jonathan may call to ask more questions and get to know you!
Have you left a high-control group/cult? If so, from which one?
If you are not a cult survivor, what is your unique perspective or level of expertise? (ie. cult expert, professor, author, psychologist)
In a few clear and concise bullet points, why is/was your group cult-like? (Who is the cult leader? Was there abuse? In what ways did manipulation occur? How were you and others harmed by it?)*
What is the most stand out part of your story, in one sentence?*
Would this be the first time you'd publicly tell your story? (it's ok if so!) If not, please provide links to other interviews or media we can watch for context*
Please provide your social media and/or YouTube channel links. Would you be willing to share your episode on your platforms?
What gear do you have access to for filming?

Camera that can be connected to my computer for streamingComputer with high quality webcamiPhone (can be used in absence of great webcam)Professional microphoneApple corded headphones (this works great for a mic)Ring lightFull recording studio with all of the aboveOther
Please upload 2 or 3 photos of yourself (your face clearly visible)*

Cancelof
Please provide a link to a 3-4 minute recording, introducing yourself. Give us a brief rundown of your story/message and why you want to be on C2C. If you have a camera/mic or studio that you'd be using, showcase that here. You're amazing! Possible upload options: Unlisted YouTube or Vimeo Video, Google Drive link, Dropbox link.*
Podcast Release for Cults to Consciousness: In exchange for the opportunity to participate on and be photographed, filmed and/or recorded on camera, video and/or audio and other good and valuable consideration, the receipt and adequacy of which are hereby acknowledged, I hereby grant to Shelise Ann Sola and Jonathan Rosales, hosts and producers of “Cults to Consciousness,” its employees, affiliates, contractors, representatives, licensees, designees, successors, agents and assigns (“Chéli Rose LLC”) the right to record my name, likeness, image, voice, sound effects, performance and stories on digital media, photographic images, film, tape, or otherwise in, and in connection with, the Cults to Consciousness production and syndication of an audio and/or audiovisual podcast hosted by Shelise Ann Sola and Jonathan Rosales. The intended use is for video, photo and/or audio participants to grant to the C2C Production the freedom to use and distribute any content recorded and/or produced online, on print, and/or in social media.

I hereby authorize the C2C Production team to publish any photographs, audio recordings or videos taken of or submitted by me, for use in any of the following: YouTube videos, print, online and/or video-based marketing materials, and any other publications related to the C2C Production. I hereby release and hold harmless the C2C Production from any reasonable expectation of privacy or confidentiality associated with any of the specified above. I also confirm that I am the sole owner of what has been provided and am able to give such authority. I further acknowledge that my participation is voluntary and that I will not receive financial compensation of any type associated with the taking or publication of these videos, audio recordings or photographs in the C2C Production marketing materials or other publications. I acknowledge and agree that publication of said videos, audio recordings and photos confer no rights of ownership or royalties upon me whatsoever. I hereby release the C2C Production, its contractors, employees and any third parties involved in the creation or publication of marketing materials, from liability for any claims by me or any third party in connection with my participation.
Type your first & last name to digitally sign this form

First NameLast Name
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Thank you for your interest in our show!