Podcast Prep Questionaire

Name

First NameLast Name

Phone Number

Please enter a valid phone number.

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Email

example@example.com

Where did you grow up?

Where do you live now?

What do you do for a living?

Short Bio/Intro

Topics you want to and are willing to discuss

Is there anything that is completely off the table? Anything you don’t want brought up at all?

Please upload a photo of yourself

How would you like people to find you or get in touch with you after the podcast airs? Website, social media, and so on.....

I hereby acknowledge that I have voluntarily agreed to be interviewed by Tawny Palm, host of the Radiant Resilience podcast. I understand that the discussions during the interview may involve the sharing of personal experiences, opinions, and other sensitive information which will be recorded and disseminated as part of the podcast episode(s).

By agreeing to participate in the Radiant Resilience podcast, I hereby grant Tawny Palm (hereinafter referred to as "the Producers"), the irrevocable right and permission to record, use, publish, stream, sell, and distribute the said interview (including any associated written, photographic, or recorded media) without any compensation to me. This includes, but is not limited to, the use of my name, likeness, voice, and any other contributions in all forms of media, now known or hereafter devised, in connection with the Radiant Resiliance podcast.

I fully understand that my participation in the Radiant Resilience podcast means that my interview, including personal stories and information, will be made public through various media channels managed by the Producers. I agree that the Producers are not liable for any repercussions, legal actions, claims, losses, damages, expenses, or liabilities of any kind that may arise, directly or indirectly, from the content shared during my interview or its subsequent publication and dissemination.

I hereby release and discharge the Producers from any claims, demands, or causes of action that I may have now or in the future by reason of anything contained in the recordings or the use thereof, and I agree that I shall not bring any claims against the Producers relating to my participation in the Radiant Resilience podcast.

I affirm that I am over the age of 18 years and have read this release form before agreeing to it, fully understanding the contents, meaning, and impact of this release. I understand that I am free to address any specific questions regarding this release by submitting them to the Producers before signing and that I have been advised to consult with legal counsel of my choice prior to signing.

I have read and agree to all of the above terms and conditions*