MouthMedia Network

Guest Intake Form

Thank you for agreeing to be a guest on a MouthMedia Network podcast. This form assists us in preparing for production and promotion of your episode.

Because there is a legal release involved, each individual guest who will participate in a MouthMedia Network show should complete this form personally.

Which of our shows are you scheduled to appear on? *
Name *
Name
(it's okay to write TBD if you don't know yet)
(or your assistant, really just whoever else might be coordinating your participation in the show)
http://
http://
Which accounts should we tag when promoting the episode?
http://
Participation Release *
By confirming my agreement to participate in an episode of a MouthMedia Network podcast, I hereby grant to Open Source Business Inc. and Mouth Media Network Inc., their affiliates and their respective employees and agents (collectively, “MouthMedia”), the right to take, use, copy, produce, publish, republish, modify, edit, distribute, perform and display the audio and/or video recordings and photographs in which I may be included, in conjunction with my name, in any film, audio tape, video tape, and/or written transcript produced by or for MouthMedia and in any related promotional, advertising, marketing and publicity materials in any and all media throughout the world, including on the internet (including all mobile networks, ecommerce channels and applications), with no restriction as to time. I release and discharge MouthMedia from all claims and liability relating to any use of the photographs, transcriptions, audio and/or video recordings. I have received valuable consideration in exchange for this release and will not be entitled to any additional compensation for the rights granted under this release. I confirm that I am at least 18 years of age and have the right to grant this release.
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