League Podcast Interview Consent Form
Please complete this form to provide your consent for participating in a League Podcast interview. Your responses ensure we have the necessary permissions to record, distribute, and promote your episode.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number (for scheduling/communication)
Please enter a valid phone number.
Format: (000) 000-0000.
Preferred Pronouns
Please Select
She/Her
He/Him
They/Them
Other
Organization or Affiliation (if applicable)
Role or Title
Podcast Episode or Topic
*
Do you consent to audio and/or video recording of your interview?
*
Yes, I consent to audio and video recording.
Yes, I consent to audio recording only.
No, I do not consent to being recorded.
Do you grant permission for the League Podcast to edit, distribute, and promote your interview on all platforms (audio, video, print, online, social media, etc.)?
*
Yes, I grant full permission.
Yes, but with restrictions (please specify below).
No, I do not grant permission.
If you have any restrictions or conditions regarding the use of your interview, please specify them here:
Would you like us to mention or promote any of your personal or professional links (website, social media, etc.) during the episode? If yes, please provide details.
Consent and Release Agreement
*
Signature
*
Date of Consent
*
-
Month
-
Day
Year
Date
Submit Consent
Submit Consent
Should be Empty: