Podcast & Media Speaking Request Form
For speaking events or training, please fill out the appropriate form
Who are you requesting as a guest?
*
Please Select
Multiple
Any
Nichole Schmidt
Jim Schmidt
Tara Petito
Joe Petito
If you're not sure, select multiple/other
Your Email
*
example@example.com
Date of recording?
*
If you're not sure, put TBD
Are your dates flexible?
Please enter “Yes” if you are flexible with the date, or provide the dates you would be able to adjust to, if known.
What is the topic of discussion?
*
Media style
*
Please Select
Print
Television
Podcast
Documentary
Other
If other, please explain
If Podcast, which podcast category?
Please Select
True Crime
Health & Wellness
Education
Business
Entertainment
Lifestyle
Other
Tell us about your show....
*
Please tell us the title, brief synopsis, and any additional information about show
Would you be willing to share your monthly stats of downloads/listens?
Will the interview be in person or virtual?
*
In person
Virtual
IF IN PERSON, will travel be covered?
*
Yes
No
N/A
Is there an honorarium or donation to foundation offered?
*
Yes
No
Submit Request
Should be Empty: