Podcast Guest Form
Name
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First Name
Last Name
How you want to be introduced
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Organization
Phone Number
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Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
E-mail
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example@example.com
Personal Website
Social Media Links
Tell us about your health journey
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What are 3 topics would you share about
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When would you be available to do a broadcast? Keep in mind this will be MDT (mountain standard time zone) MAKE SURE TO CLICK THE TIME SLOT BELOW TO BOOK RECORDING..... DO NOT change to your time zone or you will not be booked to record.
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Have you ever shared your story to public before? Where and When?
How did you hear about us?
Google Search
Referred by________________________
I'm a listener of The Chronic Truth Podcast
Our Website
Social Media
I, hereby grant Kimberly Nash and The Chronic Truth Podcast the right and permission to record, use, publish, distribute, and promote my voice, likeness, image, name, and any statements made during my podcast appearance, in whole or in part, without restriction. I understand and agree that: 1. Ownership & Use – The recorded content will be owned by The Chronic Truth Podcast and may be used in various formats, including but not limited to, audio recordings, video content, promotional materials, social media, and marketing campaigns. 2. No Compensation – I will not receive financial compensation for my participation, and I waive any rights to royalties or other benefits. 3. Editing & Distribution – The podcast reserves the right to edit, modify, and distribute the recording as seen fit for promotional, educational, and commercial purposes. 4. Revocation of Consent – I understand that once the podcast episode is published, I cannot revoke this consent, as The Chronic Truth Podcast will have already invested time and resources into production and distribution. 5. Legal Release – I release and discharge The Chronic Truth Podcast, Kimberly Nash, and any affiliates from any claims, demands, or liabilities related to my participation in the recording.
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