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Military Birth Talk Podcast Guest Form
Thank you for your interest in sharing your story on the Military Birth Talk Podcast! Please fill out the form below with as much detail as you feel comfortable sharing. It's important to us to cultivate a diverse and wide-ranging set of stories that encompasses as many experiences as possible. The information we ask for below will help us make sure we are including as many perspectives as possible.
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Email
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Your email
Phone number (text capable)
*
Your answer
First and Last Name
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Your answer
Please share the pronunciation of your name so I can be sure to say it correctly. (e.g.: ANN-ee DEN-zull)
Your answer
How would you like to be introduced? I.e. Emily/Captain Smith/Dr. Smith/etc.
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Your answer
What pronouns should I use for you during our conversation?
Your answer
How would you like to be identified during our conversation? Select as many as apply.
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Woman
Man
Birthing person
Mother
Father
Parent
Required
What branch of the military are/were you affiliated with?
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Air Force
Army
Coast Guard
Marine Corps
National Guard
Navy
Space Force
What is/was your role within that branch? Check all that apply.
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Active Duty
Dual-mil household
Spouse
Dependent
Reservist
I am a veteran/retired
My spouse is a veteran/retired
Other:
Required
How do you identify racially?
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Your answer
Where are you currently stationed or do you currently live?
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Your answer
Do you have reliable internet and a quiet place you can record?
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Yes
No
Other:
How many birth stories do you plan to share?
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1
2
3
3+
Please provide a brief synopsis of your birth story/stories.
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Your answer
Following your birth story/stories, we'll move into a Q&A portion of the interview. Your answers to the questions below will inform the questions I'll ask you during this portion of the interview.
Are there other aspects of your identity that were not covered in the questions above that are important for us to include, or that impact your story/stories?
Your answer
What is one aspect of your birth story/stories that you'd like to focus on during our conversation, or for your story to bring awareness to?
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Your answer
In what way did your military service or affiliation impact your pregnancy/birth/postpartum experience?
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Your answer
If you'd like us to tag you in our promotion of the episode on Instagram, please provide your username here.
Your answer
Do you consent to our using photos of you (shared by you) on social media to promote the episode (Instagram/Facebook/LinkedIn/YouTube)? This is not required in order to record with us!
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Yes, I will provide photos to use for promotion
No, I do not want to share photos.
Do you consent to our sharing brief VIDEO clips from the interview on social media to promote the episode (Instagram/Facebook/LinkedIn/YouTube)? This is not required in order to record with us!
*Please note that the full published episode will be AUDIO only.
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Yes, you may use video from our conversation on social media.
No, you may not use video from our conversation on social media.
If your story is selected, we'll reach out from the email podcast@mbrnpc.org. To ensure this does not go to spam, please add that email address to your mail contacts, or keep an eye on your spam folder.
*
Agree
Required
A copy of your responses will be emailed to the address you provided.
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