MEDIA REQUEST FORM

Podcast/Show Name*
Show Host Name*
Contact Name
(If other than the Host)
Contact Email Address*
Website Address*
Target Audience*
Who Tunes In
Podcast/Show Niche*
(Business, Sports, Health, Self-Help, etc.)
Monthly Downloads/Views*
How The Show is Promoted*
Are you able to provide small video/audio bites from the interview for us to share as well?*
Scheduling Link
Please provide a link to your online calendar:
Referred By:
(If someone connected us, or you heard about me through a friend, it helps to mention here so I can thank them.)