Podcast Guest Information

First Name *

Last Name *

Phone *

Email *

Which country are you attending the interview from? *

Business Name

Title of your topic. What will you be speaking about? *

Provide details on your topic. THIS IS NOT YOUR BIO. (Explain what your topic is about in 100 words or less) *

What are THREE (3) things that our audience will learn from your interview? *

Your introduction/biography in 200 words or less. HOW DO YOU WANT TO BE INTRODUCED (use 3rd person - not 'I', 'we', 'us', 'me') *

Your profile picture *

Facebook link:

LinkedIn link:

Website and other links: *

Do you have a product or service that you would like to promote? *

Yes

Link (https://) to your product or service (if applicable)

Media Release (required):

I agree to allow Healing Through Love: *

to use my profile picture image for promotional purposes,

to use my biography and website and social media links for promotional purposes,

to use the video/podcast or parts thereof for promotional purposes.

I agree that ownership of the podcast, Healing Through Love, and any content that is produced in connection with that podcast, Healing Through Love, is the sole property of Healing Through Love.

I agree to promote my episode with my networks, e.g., emails, social media, or website.

Signature

First and Last Name *

Date *

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