Name
*
First Name
Last Name
Email
*
Profession
Age Range
What are your interest/hobbies
Social Media Handles
*
Brief Description of Your Ostomy Journey
*
Duration of Living with An Ostomy
*
Type of Ostomy
*
Life After Ostomy - Brief Description
*
Is there a specific topic or message you want to touch on
Ostomy Supplies
Photo's for Promotion
Please email a headshot and one other photo that you love to LeeAnne@leeannehayden.com
2. Audio and Video Recording Consent:
*
I understand that both audio and video of the podcast episode will be recorded and may be used for promotional and broadcasting purposes, including publication on platforms like YouTube, Instagram, Apple Podcasts, Spotify, and iHeartRadio. Additionally, a blog post about the episode may be written and published on LeeAnnehayden.com
Instagram Collaboration
*
Would you like to be tagged or collaborate on the Instagram post for the video portion of the podcast?
Legal Disclaimer and Consent
*
By submitting this form, I hereby grant "The Beautiful Bag" Podcast the right to use my name, voice, likeness, and any content I provide during the podcast recording in any media, including but not limited to audio, video, and any digital formats for the purposes of advertising, marketing, and broadcasting. I acknowledge that the podcast episode may be uploaded to platforms like YouTube, Instagram, Apple Podcasts, Spotify, and iHeartRadio, and a blog post about the episode may be written and published on LeeAnnehayden.com, making the content accessible to a wide audience.
I confirm that all the information I have provided is accurate and true to the best of my knowledge. I release "The Beautiful Bag" Podcast from any claims, demands, or liabilities arising from the use of the content as agreed herein.
I have read and agree to the terms and conditions mentioned in the legal disclaimer
