Thomasino Media Interview Template

Social Good Conferences Speaker Registration

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Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Website URL
Social Media Facebook
Social Media Instagram
Social Media LinkedIn
Social Media TikTok
Social Media others
YouTube
Tell us about yourself

0/300
Why are you passionate about your mission ?

0/500
Top 3 Lessons to Share?

0/500
Call to Action for Audience
File Upload

Attachments. Please provide 4-6 professional photographs and your business logo for inclusion in conference materials and for promotional use on social media.
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How did you hear about us?

Other
Social Good Conferences You Are Interested in Participating

Other
What Month of The Social Good Conferences are you interested in filming during?
Submission Process

Please keep in mind that all submissions are subject to review and approval by Thomasino Media LLC and Buddytown Consulting LLC staff. Modifications may be required before publishing or acceptance of submission. Unfortunately, not all submissions are accepted and if that is the case we will refund your Speaker Registration Fee. If accepted there are no refunds. We appreciate your interest in sharing your Social Good Conferences. After submission please schedule a time for our 45 minute session for coaching, filming and speaker readiness.
I, hereby grant permission to Thomasino Media LLC and Buddytown Consulting LLC, the creator and publisher of "The Social Good Conferences" to conduct an interview with me and to use my name, image, and likeness in connection with the interview, including without limitation, in the publication of the interview in print, online, or in any other medium or format. I understand and agree that I will not receive any payment or compensation for the interview, and that Thomasino Media LLC and Buddytown Consulting LLC, the author of the creator and publisher of "Social Good Conferences" shall have the right to publish, reproduce, distribute, and otherwise use the interview and my name, image, and likeness in any manner that it deems appropriate, without further permission from me or any compensation to me.
I understand that Thomasino Media LLC and Buddytown Consulting LLC, the producers of "The Social Good Conferences" will be relying on the representations and warranties set forth herein, and I agree to indemnify and hold Thomasino Media LLC and Buddytown Consulting LLC and its affiliates, and their respective directors, officers, employees, contributors, agents, and representatives, harmless from and against any and all claims, damages, liabilities, costs, and expenses (including reasonable attorneys' fees) arising out of or in connection with any breach of such representations and warranties. This release shall be binding upon me and my heirs, executors, administrators, and assigns.
I represent and warrant that I am at least 18 years of age, and that I have the full right and authority to enter into this release and to grant the rights set forth herein.
By typing my full name below, I am electronically signing this release and agreeing to all of its terms.*
Submission Date

MonthDayYear
Date

My Products

Speaker Registration Fee

1 45 minute planning, practice coaching and recording session, 1 10 minute recorded speaking session, 1 conference panel discussion, promotional social media posts, press release mention with other speakers, recording of segment featured on applicable Thomasino Media distribution channels

$999.00 Quantity
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Social Good Conferences Speaker Registration

Submission Process

My Products*

My Products