Activate Humanity Network
PODCAST GUEST FORM
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PODCAST GUEST FORM
Name of Guest
Preferred Nickname and Pronouns
Preferred Title or Role for Introduction (copy)
Email of Individual
Social Media Links
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You can upload up to 3 files.
Please provide a high-resolution headshot to utilize in the podcast promotional materials
Topics you would like to discuss:
Takeaways or theme for our discussion you want listeners to understand:
I agree to the following terms
The above named Guest does hereby consent to the recording and distribution of reproduction(s) of the Guest's voice and performance as part of the media program entitled “Humanity Explored” (herein referred to as the "Program"). This is to confirm that the undersigned has agreed to be interviewed or otherwise participate in the Program, a production of the Humanity Explored.
As a condition of publication/broadcast and for no monetary compensation, Humanity Explored requests the non-exclusive worldwide rights to reproduce, distribute, and sell your oral and/or video presentation, in whole or in part, in any media, as part of this Program published under the auspices of Humanity Explored and to license these rights to others, in perpetuity. Humanity Explored shall have the right to edit and/or transcribe your presentation.
You also grant Humanity Explored the right to use your name, biography and likeness in connection with the Program.
You warrant that your presentation is original with you, that publication/broadcast will not infringe on the rights of others, and that you have full power to grant this license. Should your presentation/broadcast incorporate copyrighted materials of others, you warrant that you have obtained such permission from those parties for publication/broadcast by Humanity Explored, consistent with this Agreement.
If the foregoing terms are satisfactory, please sign and date this agreement below and return it to the Program coordinator. Execution of this Agreement does not obligate Humanity Explored to publish your presentation or other materials.
I hereby consent to the use of my oral and/or video presentation as described and agree with the provisions of this release form:
Date of Agreement