Dental Hygiene Basics Podcast
I am so excited to have you on the podcast! I typically record episodes 6 months in advance, so there will be a delay between the recording and the release of the episode. Please complete the guest release form and upload your preferred headshot and bio. Feel free to reach out with any questions to info@dentalhygienebasics.com.
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Please upload your preferred headshot here (you may include multiple)
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The above-named Guest does hereby consent to the recording and distribution of reproduction(s) of the Guest's voice, video, and performance as part of the media program entitled “Dental Hygiene Basics” (herein referred to as the "Program"). This is to confirm that the undersigned has agreed to be interviewed or otherwise participate in the Program, a production of the DH Basics, LLC. As a condition of publication/broadcast and for no monetary compensation, DH Basics, LLC requests the non-exclusive worldwide rights to reproduce, distribute, and sell your oral and/or video presentation, in whole or in part, in any media, as part of this Program published under the auspices of DH Basics and to license these rights to others, in perpetuity. DH Basics shall have the right to edit and/or transcribe your presentation. You also grant DH Basics, LLC the right to use your name, biography, image, and likeness in connection with the Program. You warrant that your presentation is original with you, that publication/broadcast will not infringe on the rights of others, and that you have full power to grant this license. Should your presentation/broadcast incorporate copyrighted materials of others, you warrant that you have obtained such permission from those parties for publication/broadcast by DH Basics consistent with this Agreement. If the foregoing terms are satisfactory, please sign and date this agreement below and return it to the Program coordinator. Execution of this Agreement does not obligate DH Basics, LLC to publish your presentation or other materials. I hereby consent to the use of my oral and/or video presentation as described and agree with the provisions of this release form:
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Next Steps:
After you complete this form, you will be redirected to the website to schedule your recording. A confirmation email with the list of podcast questions will be sent to your email. You can cancel or reschedule at any time using the links in the confirmation email.
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