Join My Survivor V.O.I.C.E.: The Podcast
My Survivor V.O.I.C.E. is a monthly podcast where women of color get to share their stores of survival. Let your Voice Of Independence, Closure, & Empowerment be heard!
After completion of this interest form, you will be contacted to discuss details and availability for participation.
Full Name *
Email Address *
Phone Number *
Introduce yourself. (Short Bio) *
List your active social media monikers and/or website. *
Are you a survivor of: *
Is there anything you'd like to promote during the podcast? If so, list below.
Please list any topics you are not comfortable with discussing. If nothing is off limits, please indicate that below. *
Provide 3 dates and times you would be available for a 10-15 minute phone conversation to discuss participation. *
You grant permission to the My Survivor VOICE podcast media team and Our 3 Memorial Foundation, Inc., hereinafter known as the “Media” to use your image (photographs and/or video) for use in Media publications including: All Social Media Platforms, Website (, traditional media (TV, Radio, Print ads) and other purposes it may serve. You hereby waive any right to inspect or approve the finished photographs or electronic matter that may be used in conjunction with them now or in the future, whether that use is known to you or unknown, and waive any right to royalties or other compensation arising from or related to the use of the image. You are 18 years of age or older and you are competent to contract on your own name. You have read this release before submitting this form, and fully understand the contents, meaning and impact of this release. You understand that you are free to address any specific questions regarding this release by submitting those questions in writing prior to submitting, and agree that your failure to do so will be interpreted as a free and knowledgeable acceptance of the terms of this release. *
Today's Date. *
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