On-Air Coaching Form
Filling out this form puts you in consideration for a free 20-30 minute podcast coaching session. By filling this form out and being chosen, you agree to be on the podcast to talk through where you want to move to, what it would take to get there and suggestions I'd make to get you there. 
Email *
Name *
Email *
Address *
Phone number *
Where do you want to move to? You can list multiple cities. *
When was the last time you visited that city *
How much research have you done on this move or city so far? *
What's compelling you to move there? *
What's your biggest fear around moving? *
What do you think is holding you back? *
What's really holding you back? *
What do you hope to get out of our session together? *
Have you ever had professional coaching before? *
If there was a membership community you could join to meet other people considering a move (or future friends in your new city) would you join it if it was reasonably priced? *
What's reasonably priced? *
Are you flexible with your schedule to find a good recording time which could be on a weekend? *
By submitting your email address, I'm assuming you'd like to be on my mailing list if you aren't already- that's how you get the 'Moving For Smarties' guide! *
The Legal Stuff
Podcast Release and Consent Agreement

1. Parties
This Podcast Release and Consent Agreement (“Agreement”) is entered into by and between [Moving Tips + Tricks For People Considering A Relocation Podcast] (the “Producer”) and the undersigned individual (the “Participant”).

2. Consent to Record
The Participant hereby consents to being recorded in audio, video, and/or photographic form during participation in the podcast episode titled [Coaching: Name of Guest], recorded on [Date TBD] (the “Recording”). The Participant understands that the Recording may include their voice, likeness, image, and/or statements.

3. Grant of Rights
The Participant grants to the Producer, its successors, assigns, licensees, and agents a perpetual, irrevocable, worldwide, royalty-free right and license to use, reproduce, distribute, publicly perform, display, edit, and create derivative works of the Recording (in whole or in part) in any media now known or hereafter developed, for any purpose, including but not limited to promotion, advertising, and marketing, without further compensation or approval.

4. Waiver of Rights
The Participant waives any right to inspect or approve the finished product or any use to which the Recording may be applied. The Participant further waives any claims to compensation or royalties arising from the use of the Recording, including any claims for moral rights or infringement.

5. Release of Liability
The Participant agrees to release, indemnify, and hold harmless the Producer and its officers, directors, employees, agents, and affiliates from any and all claims, demands, liabilities, or causes of action that may arise out of or in connection with the use of the Recording, including any claims of defamation, invasion of privacy, or infringement of any rights, except where such claims are prohibited by law.

6. Representations and Warranties
The Participant represents and warrants that they have full authority to grant the rights provided herein and that their participation and any statements made do not violate or infringe upon the rights of any third party.

7. Governing Law and Jurisdiction
This Agreement shall be governed by and construed in accordance with the laws of [IL State/United States of America]. Any disputes arising out of or relating to this Agreement shall be subject to the exclusive jurisdiction of the courts located in [Cook County, IL, USA].

8. Entire Agreement
This Agreement constitutes the entire agreement between the parties regarding the subject matter herein and supersedes all prior or contemporaneous understandings, whether written or oral. Any amendments or modifications to this Agreement must be in writing and signed by both parties.

9. Acknowledgment and Acceptance
By signing below, the Participant acknowledges that they have read, understood, and voluntarily agree to be bound by the terms of this Agreement.

 *
A copy of your responses will be emailed to .
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Google Forms