Podcast Guest Form and Audio Recording Release Form
Please fill out this form to sign up to be a guest on the Bariatric Warrior Podcast, and to grant us permission to use your audio.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
What is your Instagram or TikTok Handle?
*
What Days of the Week, Times, and Dates work best for you to record. Include time zone.
*
Do you have a specialty/skill/topic you want to highlight/discuss?
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What Surgery did you have?
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VSG gastric sleeve
RNY gastric bypass
Revision to bypass
Duodenal Switch/Sadi Sip
Gastric band/baloon
GLP-1 or Other Weight Loss Medication
Pre-Op
No Surgery
Other
Did you have any complications from your WLS?
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YES
NO
MAYBE
Other
Please upload a photo of yourself for us to use in the podcast advertisement.
*
Browse Files
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Choose a file
Cancel
of
Do you agree to contact either Steph or Bex at www.bariatricwarriorsupport.com at least 48 hours in advance to cancel in the event you are unable to attent?
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I hereby grant permission to use my audio recording for promotional and commercial purposes.
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I hereby grant permission to use my picture and name for promotional purposes including posting on websites and social media (example: Facebook, Instagram, TikTok, Spotify, Youtube, etc.)
*
Terms for show promotional material and rights to use content
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By checking this box, you acknowledge and agree that Bariatric Warrior Podcast has permission to record, use, and repurpose any submitted or recorded content, including video, audio, and written responses for promotional purposes across all streaming platforms, social media platforms, websites, and marketing materials.
Signature
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