Home 9 Cultivate an Exceptional Life Podcast 9 Podcast Intake

Podcast Intake Form

Thank you for agreeing to be a guest on the Cultivate an Exceptional Life podcast! I am excited to have you. Please complete the following form. This will help ensure we have everything we need to interview, produce, and promote the podcast you are a guest on.

Once this form is completed you will taken directly to our calendar system where you can select a date and time to record your interview. I can’t wait, because I am excited to share your knowledge and experiences with our audiences.

Podcast Intake Form

CONTACT INFORMATION

Address
Address
City
State/Province
Zip/Postal
Country

BIO

Please tell me a little bit about yourself, so that I can introduce you on the podcast. (Ex: where you have lived, worked, passions, awards, family, creative endeavors or personal interests important to you). This is a little bio of sorts. Please write in the third person and keep it to five sentences or less.

YOUR IMPACT

PROMOTION

Do you want to be able to have people contact you after the show? (Ex: on a website or on Facebook if they really connect with you and your story). If yes, please share your contact information.

Maximum file size: 15.36MB

Will you be giving the podcast listeners something?

AGREEMENT

For consideration which I acknowledge, I consent to the recording of my statements and grant to Leisa Watkins (“Host”) 
and the Host's assigns, licensees, and successors the right to copy, reproduce, and use all or a portion of the statements (the “Interview”) for incorporation in the Cultivating An Exceptional Life (the “Podcast”).

I permit the use of all or a portion of the Interview in the Podcast in all forms and media including advertising and related promotion throughout the world and in perpetuity. I grant the right to use my image and name in connection with all uses of the Interview and waive the right to inspect or approve use of my Interview as incorporated in the Podcast. I release the Host and the Host's assigns, licensees, and successors from any claims that may arise regarding the use of the Interview including any claims of defamation, invasion of privacy, or infringement of moral rights, rights of publicity, or copyright.

I acknowledge that I have no ownership rights in the Podcast. The Host is not obligated to utilize the rights granted in this Agreement.

I have read and understood this agreement and I am over the age of 18. This Agreement expresses the complete understanding of the parties.

Scheduling

Questions I Would Like To Ask