Looking forward to the interview! (Backup Form)
If you are completing this Google Doc, you may have had some issues submitting our primary form. Thanks for your patience. 

Complete the form below, after you complete the form, you will see the link to schedule your interview. If you have any problems the link is also below on this form. 

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Have you been a guest on the I AM CEO Podcast before?
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Name - First & Last *
Email address *
Short bio (Please in 3rd person) to read during interview - max four to five sentences *
Phone number *
Website *
Any other additional social media links, book links, etc.(Required)
Headshot *
Please include a link to your headshot
Address
Do you have other people to notify? Publicity Manager? PR Agency? Assistant? Etc. 

Enter their name, email address and phone number below
How would you like to record?

We will record on Zencaster with Zoom being a backup. You have to record via your computer and I will ask prior to hitting the record button (you don't have to decide now) but just as a reminder, you can do audio and video OR just audio. It's the same process. We will just repurpose the video content at a later date.
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Please check the following that apply *
Required
OFFLINE: Are you looking for any referrals or connections?

E.g. a specific type of client, connection or more podcast interviews, etc.
Who or what is a good referral for you

We've interviewed over 1000 guests and always try to play the connector when we can, so do you have someone that would be an ideal referral partner or someone that you would like to meet or who's your ideal client?
How did you find out about our podcast?
OFFLINE: Advice for our community (OPTIONAL)

Any additional advice you would want to tell our community? We are building a community and you can place it here or it can also be recorded after our interview. 
Do you want to receive our weekly CBNation Buzz Newsletter?

We will send you an email with more details. You may unsubscribe anytime. 
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Interested in any of the following? *
Required
OFFLINE: Recommendation's Name? *
Who would be a good guest to be on the show? if not, you can enter n/a

Could you provide the e-mail address for your recommendation? We will only use this to reach out to see if he/she might be interested in being on the show. We typically don't reach out until after your podcast goes live but if you wanted to connect earlier, that's fine too :-)
OFFLINE: Recommendation's Email Address?

Could you provide the e-mail address for your recommendation? We will only use this to reach out to see if he/she might be interested in being on the show. We typically don't reach out until after your podcast goes live but if you wanted to connect earlier, that's fine too :-)
 *
Who would be a good guest to be on the show? If not, you can enter n/a
OFFLINE: Recommendation's Phone Number
How else can we help?
Anything additional?
OFFLINE: Any other details? *
If not, you can type N/A
I agree to the podcast release (see below) *
Required
Save the link below and then submit the form
Save this link below after you click submit to make sure you are signed up for the podcast. 

Podcast Release
PODCAST GUEST RELEASE
Agreement by and between Blue16 Media, Progreshion LLC, 2800 Eisenhower Ave. Alexandria, VA 22314 (the “Producer”), producer of the podcast entitled CEO Podcasts (the “Program”), and: the undersigned guest (the “Guest”, “I”, or “Me”) in connection with Guest’s appearance for an interview (or performance) (the “Interview”) for the Podcast. The parties hereby agree as follows:
CONSENT: Guest does hereby irrevocably consent to appear in the Program and to be recorded, filmed, videotaped or otherwise to have their voice and performance captured, reproduced and distributed. Guest further agrees that the Producer shall have the exclusive right to edit the content of and to make derivative works using the Interview.
NAME & LIKENESS: Guest hereby irrevocably authorizes Producer to use Guest’s name, image, likeness, appearance, voice, professional and personal biography(ies) and all materials created by or on behalf of the Producer incorporating the same in perpetuity for any lawful purpose, including, but not limited to advertising, public relations, publicity, packaging, and promotion of Company and its businesses, products, and services, without further consent from or royalty, payment, or other compensation.
OWNERSHIP: It is understood that Guest retains ownership of any copyrighted material provided during the Podcast, however the Producer is hereby granted a non-exclusive, perpetual, worldwide and royalty-free license to publish such copyrighted work in any and all media, whether now known or hereafter devised.
Guest further acknowledges that the Producer is the sole owner of all rights in and to the Interview, the recording(s) thereof, the Program, as “works made for hire” pursuant to 17 USC §101, et.seq., for all purposes; and that Producer has the unfettered right, among other things, to use, exploit and distribute the Program, and Guest’s performance as embodied therein in any and all media or formats, throughout the world, in perpetuity. To the extent this provision does not convey full ownership of the Interview Guest hereby irrevocably transfers, assigns, and otherwise conveys to Producer all of Guest’s right, title, and interest, if any, in and to the interview, including all copyrights and other intellectual property rights in the interview. Any materials created in connection with the production and distribution of the Program (“Materials”) become property of Producer, and Producer shall have the sole and exclusive right to use, exploit and distribute such Materials, throughout the world, in perpetuity
NO OBLIGATION TO USE: Nothing contained herein shall be construed to obligate the Producer to use or exploit any of the rights granted or acquired by Producer, or to make, sell, license, distribute or otherwise exploit the Program or Materials whatsoever.
NO ADDITIONAL CONSIDERATION: Guest understands and agrees that the opportunity of the Interview constitutes sufficient consideration hereunder, and that Guest shall receive no monetary compensation for appearances on and participation in the Program.
RELEASE; WAIVER: Guest hereby releases and discharges Producer from any and all liability arising out of or in connection with the making, producing, reproducing, processing, exhibiting, distributing, publishing, transmitting by any means or otherwise using the Program, and, to the fullest extent permitted by law, waives all legal and equitable claims (whether now known or later discovered) relating to the Program whatsoever.
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