Story or Podcast Interview Guest Form
If you are interested in being a guest on the "Inside Out with Courtnaye" podcast or a featured story, please take a moment to fill out the guest/interview form.
Who is the contact person for this interview?
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Guest
Assistant
PR Representative/Publicist
Guest Name: (please fill the guest name, even if you are a PR rep or assistant)
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First Name
Last Name
Email: (please provide the best contact email)
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example@example.com
*If you are not the guest filling out the form, as a PR rep or publicist, please add your name and agency below. NOTE: If you are an administrative assistant to the guest, please add your name and role below. *This is required to proceed if you are not the guest.
What has the Lord placed on your heart to share with the world (i.e., listeners, viewers, readers, etc.) right now? Please list 3 topics you or your client can talk about on the show or in a story? Feel free to give as much detail as possible for clarity purposes (but not too long ;-))
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Please provide interview questions (7), please type in the questions that you would like me to ask during our time together. NOTE: If you are a PR Rep and have the questions in the media kit already, that works perfectly. ;-)
Do you agree to help promote your episode by sharing it with your audience as well? Please select the areas that best suit your willingness to help spread the message further.
Yes
No
Social Media
Email
Please share a bio: (30-50 words only please)
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File Upload: Please share a professional headshot here...
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File Upload: If you have a book or resource image that you would like to share during the show or to include with your interview, please add it here...
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File Upload: If you have a media kit, please submit it here...
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Special BONUS: Host Read Commercial/Product Mention (this is optional if you're interested in me doing a "Host Read" commercial about your product or service in my podcast. If so, please let me know which option you're interested in? NOTE: This commercial will be during and featured after our podcast interview for additional publicity of your product, ministry, business, brand, or service). If you're not interested in additional marketing, please proceed to the signature below.
Host Read - Beginning of the Show - $500 (aired in 3 episodes and your link in the show notes)
Before going to the commercial break (Mid Show) - $350 (aired in 2 episodes and your link in the show notes)
End of the Show - $250 (aired in 1 additional episode and your link in the show notes)
By signing, you agree that Courtnaye Richard of Inside Out Media Group, LLC has the right to accept or decline an interview and is able to use your headshot, bio, audio, and video for promotional use and for the podcast and/or featured article, and has the right to edit your interview/story as needed for the effectiveness of serving the listeners, readers, or viewers. Please sign below if you agree below.
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