The FireWife Community Interview Application
Thank you so much for your interest in being interviewed for our Podcast and The FireWife Community. We consider it a privilege to be able to interview you and share your story, struggles and inspiration within our community. Please, fill out this form as completely as possible. Filling it out does not guarantee an interview, but allows us to get to know you better so we can book you for the podcast!*There was an overwhelming response for this, which shows me the need for our stories to be out there! Please be patient as we get the scheduling set up!
Name
*
Email
*
Phone number
*
IG Handle if applicable
Are you in a relationship with a First Responder?
*
Please Select
Yes
No
I am in the industry of EMS
Facebook URL
Short Introduction to you and your family
*
What topic(s) are you passionate about in the fire life?
*
What advice would you want to share?
CONSENT & RELEASE Consent Form As a Guest of the "Just a Girl and Her Firefighter podcast" (“Podcast”), I consent to the audio and/or video recording of my name, my voice, and my image as part of my appearance on the Podcast. I further consent to the distribution and broadcast of my appearance, including any information and content I provide, by Kristi Hilmer (“Podcaster”) in audio, video, or text form without restriction. I further acknowledge and agree: By filling out this form, it does not guarantee an official booking or complete production on the podcast, but it does give my intent to be a guest on the podcast. (a) There will be no monetary compensation for my appearance. The consideration I receive for executing this release shall be the exposure I receive to the audience of the Podcast. (b) I grant the Podcaster a non-exclusive, royalty-free, perpetual, worldwide license to publish any copyrighted work I supply as part of my appearance on the Podcast. (c) I hereby waive any right to publicity and privacy claims, and agree my name, likeness, and business information may be used by Podcaster in the episode in which I appear and future reproductions as well as the marketing materials supporting the Podcast in general. (d) I am waiving any intellectual property claims including, but not limited to, trademark and copyright infringement claims, associated with personal or business interests discussed during my appearance on the Podcast. (e) That Podcaster is the sole owner of any all rights to the Podcast, including the episode in which I appear. I further acknowledge and agree that Podcaster has the right to edit the content of my appearance and publish the same in any media now and in the future without first obtaining my approval. (f) I am releasing and discharging Podcaster together along with all of the Podcaster’s principals, shareholders, officers, employees, agents, successors, and assigns from any and all liability arising out of or in connection with my appearance on the Podcast or the subsequent reproduction and distribution of the episode in which I appear in any medium.d Title
I agree to the above Consent & Release
*
Yes
No
I accept that typing my name below will act as my signature of consent and release*
*
Yes
No
Full Name in the agreement of Consent and Release
*
Thank you for submitting your information to be a guest on the "Just a Girl and Her Firefighter" Podcast. We appreciate your interest and the time you've taken to share your story. Our team will carefully review all submissions, and if your interview is selected for this season, we will reach out to you via email with further instructions. We look forward to possibly featuring your voice on the show!
Submit
Should be Empty: