Guest Information

* Indicates required field

Podcast title: *

Name *

First

Last

Preferred Pronouns *

Email *

Phone Number *

Preferred Title/Role *

Organization *

Brief Bio *

Headshot *

Max file size: 20MB

Facebook *

LinkedIn *

Twitter *

Instagram *

What are you excited to talk about? *

What would you like to avoid? *

Do you have access to the following equipment? *

Computer with strong internet connection High quality microphone Audio headset/earphones

Disclaimer

For consideration which I acknowledge, I consent to the recording of my statements and grant to Barry Gary (“Host”)  and the Host's assigns, licensees, and successors the right to copy, reproduce, and use all or a portion of the statements (the “Interview”) for incorporation in the The Louisville Cycling Podcast (the “Podcast”).
I permit the use of all or a portion of the Interview in the Podcast in all forms and media including advertising and related promotion throughout the world and in perpetuity. I grant the right to use my image and name in connection with all uses of the Interview and waive the right to inspect or approve use of my Interview as incorporated in the Podcast. I release the Host and the Host's assigns, licensees, and successors from any claims that may arise regarding the use of the Interview including any claims of defamation, invasion of privacy, or infringement of moral rights, rights of publicity, or copyright.
I acknowledge that I have no ownership rights in the Podcast. The Host is not obligated to utilize the rights granted in this Agreement.
I have read and understood this agreement and I am over the age of 18. This Agreement expresses the complete understanding of the parties.

Submit