Ask a Coach I Want to Participate in a Driven 2 Thrive 'Ask a Coach' EpisodeThis form is a request to be considered to be a guest as part of a recorded “Ask a Coach” session of the Driven 2 Thrive Broadcast: Purpose, Growth, and Lasting Impact For Men. I understand that this is a 45 minute commitment to be scheduled if accepted after the request is reviewed. I also understand that once recorded this will be publicly aired at a global level on the show and will NOT be pulled down for any reason later. A submission does not constitute acceptance, I understand we will only dive into one issues specifically and that if I want to go deeper i would need to schedule a 1 on 1 paid coaching session. About YouYour Name(Required) First Last Your Address City ZIP Code How Can We Reach You?We would love to chat with you. How can we get in touch?Preferred Method of ContactEmailPhoneYour Email Address(Required) Email Address Confirm Email Address Your Phone(Required)Best Time to Call You(Required)Select A Time12:00 am12:30 am1:00 am1:30 am2:00 am2:30 am3:00 am3:30 am4:00 am4:30 am5:00 am5:30 am6:00 am6:30 am7:00 am7:30 am8:00 am8:30 am9:00 am9:30 am10:00 am10:30 am11:00 am11:30 am12:00 pm12:30 pm1:00 pm1:30 pm2:00 pm2:30 pm3:00 pm3:30 pm4:00 pm4:30 pm5:00 pm5:30 pm6:00 pm6:30 pm7:00 pm7:30 pm8:00 pm8:30 pm9:00 pm9:30 pm10:00 pm10:30 pm11:00 pm11:30 pmBroadcast CapabilityThis is a request to do a recorded coaching session for the Driven 2 Thrive Broadcast that will be shared on all it’s platforms.Podcast Compatibility(Required) Stable Private Internet Access Video Capability (Camera) Microphone (audio) Headphones Quiet Place to Record By checking these you acknowledge you have the needed equipment to do a video podcastConsent to Use(Required) Podcast Guest Agreement and ReleasePODCAST GUEST AGREEMENT AND RELEASE I do hereby agree, consent to and grant to the Producer hereunder all rights related to the recording and broadcast or other distribution of reproduction(s) of my voice, photograph, likeness and performance as part of my participation as a guest on the audiovisual program entitled Driven 2 Thrive Broadcast (the “Program”). I hereby acknowledge and agree: The host of Driven 2 Thrive Broadcast is the sole owner of all rights in and to the Program, and the recording(s) thereof, together with any materials prepared for the Program (“Materials”) are “Work(s)-Made-For-Hire” within the meaning of the United States Copyright Act f(17 USC §101, et. seqor all purposes; and Producer has the unfettered right, among other things, to use, promote and distribute the Program one or more times in any and all media or formats and modes of transmission whatsoever, through-out the world, in perpetuity. I will receive no compensation for my appearances on and participation in the Program. I hereby waive the opportunity or right to inspect or approve the content of the Program. Nothing contained in this Podcast Guest Agreement and Release shall be construed to obligate Producer to use or exploit any of the rights granted or acquired herein, or to make, sell, license, distribute or otherwise use the Program or Materials whatsoever. My name and likeness may be used in advertising and promotional material for the program, but not as an endorsement of any other product or service. I hereby release and discharge Producer, together with all of Producer’s principals, share-holders, officers, employees, agents, successors, heirs, assigns and affiliates from any and all liability arising out of or in connection with the making, producing, reproducing, processing, exhibiting, distributing, publishing, transmitting by any means or otherwise using the Program and Materials. I am eighteen years of age or older, that I am fully competent to execute this agreement, and that no other agreements currently exist which would prevent my transferring these right to you, or your successors and assigns. I acknowledge that you intend to rely on this release, and the grant of rights herein contained, and shall incur significant costs in production of the Program in reliance upon same. As a result, I agree not to institute any legal action to contest the rights conveyed to you herein. Electronic Signature By typing my name above and submitting this form, I acknowledge that I have read and understand the contents of this release and am executing same of my own free will.What's on your mind?Please let us know all the details. What is it you would like some coaching help on? Be specific Tell us about what you do for a living, your work schedule, time commitments, are you married or in committed relationship or not, do you have kids, what is your living situation, what are the big goals you are working towards and what are you doing about them now? The more specific you are and the more detail the better coaching I can give you.Your response(Required)CommentsThis field is for validation purposes and should be left unchanged. Δ