Show Host - Black Mental Health Matters

Show Hosts Volunteer Application Form

Thank you for your interest in volunteering as a Show Host for Black Mental Health Matters Inc. Please fill out this form and we'll reach out to you via email if we think you'd be a great host for our show.

First Name

Last Name

phone

Street Address

Address Line 2

City

State / Province / Region

ZIP / Postal Code

social Media URL

Website

country

Do you have a background in mental health or media experience?

Are you available to prerecord shows? If yes please indicate your availability.

Is there a specific product /service /event you'd like to promote during the show? Eg. a new book or product launch,campaign,celebration,etc (If none say N/A) If yes enter below

Your Brief Biography (max 4 sentences please)

Please provide a high resolution headshot to utilize in the show promotional materials. We'll be using the image for promoting your episode

Are you happy to promote the show with your audience(email list, social media) when it airs? We'd love your support to get your episode out to many people as possible!

Media/Video/Audio Release

release I hereby voluntarily and without compensation authorize voice recording(s) to be made of me. I hereby give permission to BMHM to use, reproduce, and distribute the video or voice recordings, including my name and submitted photo(s). I hereby agree to release Black Mental Health Matters Inc from any claims, damages or liability arising out of such use or distribution. I understand that the use of my name, likeness, video and voice recordings will be primarily for the purposes of commercial use, education and/or promotion by this organization. I have read and understand the foregoing and I consent to the use of my picture, audio and/or video as specified for the above-described purpose(s). I further understand that no royalty, fee or other compensation of any character shall become payable to me. Consent - Media Release I agree to the above media/audio/video release Consent - Privacy I grant BMHM permission to collect and store my data as per the BMHM Privacy Policy.

black mental health matters

Show Hosts Volunteer Application Form

Thank you for your interest in volunteering as a Show Host for Black Mental Health Matters Inc. Please fill out this form and we'll reach out to you via email if we think you'd be a great host for our show.