Worksheet

SPEAKER APPLICATION


       We are excited to explore the opportunity to share with our followers your insights,
       philosophy, tips, tricks, and more. In order to be considered for our show,  please take a minute to
       fill out this form. Thank you and our team will be in touch,

   

1.

First & Last Name

2.

Email

3.

Phone Number

Only if we are having trouble reaching you

4.

How did you find about the CLARITY. ACTION. IMPACT PODCAST?

5.

Share a Short Bio (300 words or less) and tell us about yourself.

6.

How would you like to be introduced on air?

We will likely ad-lib a bit, but please share how you would prefer your intro to go by finishing the following sentence!

"We are so excited to introduce our guest, YOUR NAME, who is........"

7.

Website (or where we can learn more about you)

8.

Social Media Information

Please give us your social media information so we can tag you when promoting in social media. Add as many as you have/ actively use and add any hashtags you want us to use. 

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9.

What is the CORE of your work? What problem do you solve and for whom?

10.

Any questions you'd like us to ask you on air?

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11.

What is a challenge you have overcome?

12.

What are you most proud of in your life?

13.

Are you willing to be on camera or audio only?

14.

Please Upload a recent Headshot. (High Resolution Please)

Attach file
15.

What is your favorite book of all time?

16.

Anything else we should know/focus on?