Podcast Guest Application
Hi, thanks for your willingness to share your explant experience and knowledge to help raise much needed awareness around this topic. Please complete the form below so I can learn more about you! I will reach out to you via email to schedule our podcast interview.  Excited to chat soon! Darnah xo
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Email *
Your first and last name *
Your business name (if applicable)
Email address *
Cell phone number *
Location and Timezone *
Website (if applicable)
Instagram (handle or URL link) *
If you admin a Facebook Group, please insert URL link below:
When is / was your explant surgery? *
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/
DD
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YYYY
Are there any specific points you'd like to talk about in regards to explant surgery, BII or your experience? *
If yes, please specify.
Do you give permission for this interview to be shared publicly across all our social and web platforms/channels? *
Do you give permission for us to share your before and after photos publicly with our audience? (You can provide photos via email prior to our interview) *
Are you willing to do a live Q&A with our community following the airing of our interview? (This may or may not occur) *
A copy of your responses will be emailed to the address you provided.
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