Podcast Guest Release Form Podcast Guest Release Form How’s That Working For You? A Podcast for the Therapy Curious – it's for anyone working in the mental health field who wonders if they’re doing a good job, if they know what they need to know or who sometimes ask an uncaring universe - Why didn’t they teach us about this stuff?! This podcast is brought to you by The Cairnmillar Institute - one of Australia's leading centres for psychology, counselling and psychotherapy services and an industry leader in education and training. It’s hosted by Dr Zoe Krupka and produced by Dr Christine Brown. Name * Name First First Last Last Preferred to be addressed as: Preferred pronouns Upload an audio clip of how to pronounce your preferred name Drop a file here or click to upload Choose File Maximum file size: 268.44MB Email * Phone number Podcast Episode Topic (Provided by the producer) * Biography How would you like us to introduce you in the podcast? * Include credentials that you would like for us to highlight on the podcast and in the episode show notes. Upload a photo we can use to promote the episode (max file size 250MB) Drop a file here or click to upload Choose File Maximum file size: 268.44MB Where can our audience find out more about you? Please provide a link to your professional website, LinkedIn profile, links to relevant past speaking engagements/publications. This will allow us to point our audience in the right direction if any enquiries are received. We may add these links to Podcast show notes or any social media or website posts promoting the episode. Personal/Professional Website LinkedIn Other Important Links Please separate each link with a comma In signing this release form I: confirm my agreement to participate in an episode of "How’s That Working For You?" Podcast and I hereby grant The Cairnmillar Institute (“CMI"), and their affiliates, the right to produce, publish, and distribute the photographs, transcriptions, audio and/or video recordings in which I may be included in ("Content"). hereby grant permission for my name, likeness, and the Content to be used in the podcast episode in which I appear as a guest, as well as in any other context related to the podcast (such as but not limited to promotional materials for the episode featuring me as a guest or for the podcast in general). understand that the use of my name, likeness and the Content will be primarily for the purposes of commercial use, education and/or promotion by CMI. consent to CMI deleting or editing out any of the Content and I agree that CMI has full creative rights to create a guest episode of the podcast using any of the Content and to release the guest episode on any date chosen by CMI without me first reviewing or approving the guest episode. agree to maintain the confidentiality of any and all information discussed, shared, or revealed during the podcast recording. This includes but is not limited to any personal, professional, or otherwise sensitive information. understand and agree that CMI reserves the right to cancel or postpone the release of the episode at their sole discretion. In such instances, no compensation or damages shall be owed to me. This applies to any stage of the process, including before or after the interview/recording has been conducted. release and discharge CMI from all claims and liability relating to any use of my name, likeness or the Content in relation to the Podcast. grant to CMI a royalty-free irrevocable licence to use the photographs and bio provided to them by me for the purpose of promoting the guest episode of the podcast, and the podcast generally. agree to indemnify CMI from any loss, cost or expense (including legal costs on a full indemnity basis) associated with any claim that the use of such photograph or bio in accordance with these terms infringes any third-party rights. acknowledge that CMI is the sole owner of all rights in and to the Podcast. confirm that I shall receive no compensation for activities (i.e. Interview, promotional photo shoot, etc.) in relation to the Podcast. Signature * signature keyboard Clear By signing this form, I confirm that I am at least 18 years of age and have the right to enter into these terms. Submit If you are human, leave this field blank.
