RebelRebel Podcast Guest Form
Welcome to the RebelRebel Podcast: a podcast for creative rebels and entrepreneurs.

You're filling this out because you have either been invited to be a guest on the show, or are interested in being a guest on the RebelRebel Podcast. Please complete this form to the best of your ability.

We ask for a photo to use as art for your episode. By uploading your photo you acknowledge you have the rights to that image(s), and further agree that we may use it for the episode art. If the copyright to the image belongs to someone else please let us know so we can clear it, and attribute as required.

Email address *
Your Picture (1920 x 1080 if possible)
I have the rights to this image *
Where are you located? (country, province/state, city) *
Are you a Creative Rebel, Entrepreneur, or All of the Above ... or something else entirely? *
First Name *
Last Name *
Phone Number x (xxx) xxx-xxxx *
Business Name (if applicable)
Website Addresses (add as many as you like)
Social Media Links (add as many as you like)
Describe your rebellion. What are you about? *
What else do you want to share with us?
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