New Client Consultation Form

Client Intake Form

Keever's Place, The Keever Murdaugh Show & Podcast
Name*

First NameLast Name
Name of Business, Non-Profit and/or Organization (if applicable)
Please check if your organization is a non-profit.

Yes, this is a non-profitNo, this is not a non-profit
Are a current reigning Pageant Queen?

Yes, I am a current reigning Pageant QueenNo, I am not a current reigning Pageant Queen
Date of Birth *
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Country CodeArea CodePhone Number
Email*
example@example.com
What’s the best form of contact to reach you?*

TextPhoneEmailEitherOther
If you chose phone as your best contact method, what time is best to call you?*

8am-12pm12pm-5pm5pm-8pmEitherOtherN/A
How did you hear about Keever’s Place, The Keever Murdaugh Show & Podcast?*

FacebookInstagramGoogleReferralOther
If Referral, please list name of who referred you.
Please list all your social media handles and websites.
Your Area of Expertise
What topic would you like to discuss during the show? *
Why did you choose this topic?*
What makes you an expert about this topic?*
What message do you want to portray and leave with the audience about this topic?*
Is there anything additional that you would like to share that would bring value about your topic choice?*
Are you a published author?*
If you are a published author or have written content for any magazines, blogs, etc., please tell us about your work and how to find them.
What do you hope to accomplish by being a guest on our show and podcast?*

Gain more exposureGain more credibilityIncrease incomeTeach others how to do what I am doingBe a resource or provide a serviceOther
If other please explain...
Do you understand that you are required to sign a Guest Agreement and/or Photo/Video Release to be a guest on our show and podcast?*

YesNo
Please note, you may be required to pay a guest appearance fee to appear on the show. Acknowledge this statement by clicking “I understand” below.*

I understand
Are you interested in learning about our advertising, marketing and/or sponsorship opportunities?*

YesNo
Are you interested in learning how to become an affiliate partner with us?*

YesNo
Any other information that you would like us to know?
I understand and have read and completed this questionnaire truthfully. I agree that this constitutes full disclosure, and that it supersedes any previous verbal or written disclosures.*

Yes
Signature*

Clear
Please upload a professional head shot photo. *
Please upload your bio to this form. *

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If you were not able to upload your professional head shot photo and bio into this form, then please email it to Keever's Place, The Keever Murdaugh Show & Podcast at thekeevermurdaughshow@gmail.com. Please include your name and contact information in the body of the email and send the photo and bio as attachments, instead of putting them in the body of the email. Please type "I understand" below.
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Client Intake Form

Your Area of Expertise