Application for Potty Mouth Pep Talk Podcast

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Use this to apply for a Free Potty Mouth Pep Talk. This session will be recorded and used for an upcoming podcast episode. By completing this application, you indicate your willingness to voluntarily participate in this process. Part of this process may include discussing fear, courage, self sabotage, and other vulnerable topics.
Ideal candidates will:
Will Be HONEST and OPEN
Will be Receptive to feedback, suggestions and advice in personal life and business
Will be willing to provide updates on progress upon request
Participants will not be financially compensated for their participation and will be required to sign a release if selected.

Email *

Name *

Where abouts do you live? (City, State)

What challenge/conundrum might you want to talk about on the episode?

Why do you want to receive a Potty Mouth Pep Talk with Elaine? How do you think she could help you?

If you are not chosen, are you still interested in receiving a private pep talk session with Elaine?

Yes

Maybe

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Send me a copy of my responses.

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