Pivot Now! TV Show, Guest Application

Last Name

Phone Number

Where did we meet? (be specific please)

Watching/Listening to Pivot NOW! TV Show

Networking/Conference

Referred by (provide name)

Other

If Referred by (provide the name below)

For the interview, please provide the services you provide, 3 topics you would like to discuss, and your freebie (PDF, checklist, etc).

What was the biggest pivot, problem, or struggle you have overcome in your business or life?*

Provide your Affiliate link so that we can revenue share anything you pitch, sell or enroll someone into from the show (Sign up link or special link for you to track leads) *

Please provide ALL social media, website, book URLs, and hashtags so that we can tag you in all social media posting.

Episode Title (as it relates to Pivoting)

Professional Bio

Please provide a link to your headshot (or email to [email protected])

Reviews and Followers help the show stay in the top of the charts. I would greatly appreciate a 5* Review and comment of the show. More reviews help ensure YOUR episode will be seen by more people. Thank you!

Yes, I have listened, reviewed, and followed

No, doing it right now!

Do you have a podcast, Facebook Group, Coaching group, or YouTube Channel that you would be open to inviting me to be a guest?

Yes, that would work!

No, I don't have a show

No, not a good fit

MEDIA RELEASE AGREEMENT This release allows Sibilla & Associates and Pivot NOW! TV Show to record my voice, video, photograph, and conversation during my interview with Suzanne Sibilla. This content will be released on the internet through e360 TV, Amazon Fire, Android, Facebook, LinkedIn, YouTube, and other streaming platforms. In consideration of my appearance on Suzanne Sibilla's Pivot NOW! TV Show, I grant permission to Sibilla & Associates & Pivot NOW! to utilize my appearance. I agree that Sibilla & Associates and Pivot NOW! will have permission and all copyright and other rights to such recording, photography, and video and may use the same in any and all media throughout the world in perpetuity for advertising, publicity, and promotion. I agree that Sibilla & Associates and Pivot NOW! have the right to use my name, voice, likeness, and any biographical information I've provided in connection with the Pivot NOW! TV show. This includes any related or future versions of the TV show, as well as its advertising, marketing, and promotion, across all media platforms. I confirm that, to the best of my knowledge, any statements I make during the show are truthful and do not violate any third-party rights. I agree not to make any claims against Sibilla & Associates or Pivot NOW! regarding the use of the materials as described above. I also waive and release all claims against Sibilla & Associates or Pivot NOW!, its affiliates, licensees, individuals, and anyone involved with the TV show. This release covers all versions and uses of the Pivot NOW! TV show as well as any related content or media. In the event of a dispute, I agree that California law will govern. I understand that there will be no compensation, royalties, or stipends paid as part of my participation. I am over eighteen years of age and have full legal rights and authority to consent to these terms.

Do you agree to the terms of the Media Release Agreement as outlined above?

Yes, I agree to the terms of the release.

No, I do not agree to the terms of the release

Electronic Signature: Type your full legal name below to confirm that all information you've provided is accurate and truthful.

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