Form
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Organization
Email
example@example.com
Social Media handles
Personal Website
We only record on Saturday & Sundays
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Month
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Day
Year
Date
Choose a time options( 1&2) Saturday & options (3&4) Sunday
12pm
3pm
3pm
5pm
How long would you like to record(there’s a 1 hour max)
Why do you want to be on our podcast channel?
List 3 topics you want to discuss
Tell us about yourself
Is there anything you want to promote while you’re on the episode?
Please provide high resolution headshot to utilize in the podcast promotional materials
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Would you like to become a sponsor
How did you hear about is
Google search
Referred by someone
I’m a listener
Would you like to submit a song
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Anything you want to add?
By signing with your initials you are stating that Mideus Print TV can release videos and pictures of you for our TV on all platforms.
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