Name
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First Name
Last Name
Email
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Phone
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In case the connection is not working or we have follow-up questions.
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Is your interview scheduled at a time when you will have a quiet space to record, away from dogs, children, dishes/laundry, and lawnmowers?
Yes, I will be in a quiet space.
No, I need to reschedule.
Do you have headphones that you can use during your interview?
Yes, I have headphones.
No, I do not have headphones (may cause echo during recording).
Please select the best option to describe your role.
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Lobbyist or former lobbyist (in house, contract, etc.)
Someone on the receiving end of lobbying (policymaker, regulator, etc.)
A staffer
A pollster, campaign strategist, fundraiser, or political operative
A public affairs consultant, communications director, press secretary, or other similar position
A journalist, professor, author, or researcher
A historian or parliamentarian
Other
How long have you been in this role, and what states or regions have you worked in?
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What topics or issues (health care, education, energy, etc.) have you worked on or would you most like to discuss during the episode?
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What topics are you most interested in discussing?
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Select all that apply
Is there anything else we should know about you?
Are there any stories or bills we should specifically ask you about?
Release of Liability and Waiver
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Guest hereby grants to the Podcast, program, its affiliates, agents, successors, or assigns the right and permission to record, use, publish, stream live, offer for sale, or otherwise distribute any audio or video interview or session with Guest. Such right and permission includes, but it is not limited to, the preferred name of the guest, recorded audio or video, photograph or likeness, biographical information, handouts, or any material based upon or derived during the recording.
This grant of permission does not include the release of Guest’s confidential information. For purposes of this paragraph, ''confidential information'' means real name (if not using), home address, email address, telephone number, date of birth, or other personal information.
Guest understands that the Podcast may, at its sole discretion, produce presentations or publications based in whole or in part upon Guest’s audio or video interview (or any portions thereof) and/or video or audio recordings or photographs of said interview, and that such media or transcripts may appear in print, online, or in any manner or media, including, but not limited to, promoting the Podcast or streaming audio program.
The Podcast shall have the right to edit and/or transcribe Guest’s session and/or interview. Guest waives any and all right of content approval, and any and all claims for compensation arising from the use of any audio or video recordings edited, produced, or published by the Podcast. Guest waives any and all claims (including, without limitation, claims based upon defamation) arising out of or in connection with any use, alteration, or use in any composite form hereunder of any audio or video recording given by Guest to the Podcast.
Guest hereby releases and discharges the Podcast, together with all principals, officers, employees, agents, successors, or heirs from any and all liability arising out of or in connection with the programming, the session, the making, producing, reproducing, processing, exhibiting, distributing, publishing, transmitting by any means, or otherwise using the above mentioned production.
Guest hereby warrants and represents that Guest has the right to enter into this agreement and to grant the rights granted to Podcast. Guest further agrees that during the course of the interview and/or session, Guest has not violated the rights of any third parties, including but not limited to copyrights, rights of privacy, trade secrets, or nondisclosure agreements, and that in the event of any breach of any of these warranties, Guest will indemnify, defend, and hold the Podcast harmless against any such claims. This release shall be binding upon Guest and Guest’s heirs, personal representatives, agents, successors, and assigns.
If the foregoing terms are satisfactory, please sign and date this agreement below. Execution of this Agreement does not obligate the Podcast to broadcast or publish your interview, session, or other materials.
By signing your name you agree to the release of liability and waiver.
Date
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MM
DD
YYYY
