The Digital Maddy Show

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The Digital Maddy Show - Intake Form

Dear Guest, please fill out this form to better enable us to discuss the topics you want to discuss when you are interviewed in the The Digital Maddy Show.

Email *

Name *

Email *

Phone number *

Website

Introduce Yourself *

This info is REQUIRED 24 hours prior to your scheduled interview phone call! If we have not received your bio 24 hours prior, your interview will be canceled.

Is this Your 1st Interview? *

Yes

What would you like to discuss during your interview? You may include up to THREE topics or specific questions you would like Mithyl to ask you. *

What is the call to action you would like to announce during the Podcast? *

I will be sharing the podcast links to these social media profiles: *

(Please provide links to YOUR social profile urls that you will share the podcast to, so we can connect to and thank you there!)

I will be sharing the podcast links to these social media forums/communities/groups: Put "n/a" if none *

Please list the urls of any Facebook, LinkedIn or other social media groups or communities that you will share the podcast to, so we can connect and thank you there!

Is there anyone you would like to refer to us as a potential guest to be interviewed on the "The Digital Maddy Show" podcast? Please list their names and email contact or website url below :) *

Thanks for helping us find great guests for the The Digital Maddy Show Guests should have some advice for: 1) folks who are interested in blogging, writing, and getting published either through self-publishing or a traditional publishing company, and/or 2) advice for how to mentally and emotionally cope with challenges of mental or physical disabilities while finding their voices in an able-bodied world.

PODCAST RELEASE FORM - Charkop, Kandivali West, Mumbai - 400067. Podcast Title/Topic: The Digital Maddy Show / Please sign and submit this form at lease 24 hours BEFORE YOUR INTERVIEW! =======================================This is to confirm that the undersigned has agreed to be interviewed or otherwise participate in the The Digital Maddy Show podcast described above. As a condition of publication/broadcast and for no monetary compensation, we (The Digital Maddy Show) request the nonexclusive worldwide rights to reproduce, distribute, and oral and/or video presentation, in whole or in part, in any media, as part of this publication/broadcast published under the auspices of The Digital Maddy Show. We shall have the right to edit and/or transcribe your presentation. You also grant The Digital Maddy Show the right to use your name and biography in connection with the presentation. You warrant that your presentation is original with you, that publication/broadcast will not infringe on the rights of others, and that you have full power to grant this license. Should your presentation/broadcast incorporate copyrighted material of others, you warrant that you have obtained such permission from those parties for publication/broadcast by The Digital Maddy Show, consistent with this Agreement. If the foregoing terms are satisfactory, please sign and date this agreement below and return it to the program coordinator. Execution of this Agreement does not obligate The Digital Maddy Show to publish your presentation or other materials. I hereby consent to the use of my oral and/or video presentation as described and agree with the provisions of this release form: Signature: Date: *

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