Form
Name
First Name
Last Name
Email
example@example.com
Phone Number
-
Area Code
Phone Number
List ALL of your social media handles (include a link) and size of following
What is the size of your email list?
Please include your short bio (less than 100 words)
Title of our interview and topic
What questions do you want to be sure we cover in our conversation?
If you want to provide a free gift, what is it and provide the link below
Do you agree to promote the LIVE SHOW to your email list and ALL social media a minimum of 5 times each?
YES
NO
Other
Please upload your headshot HERE
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