4. Please enter the phonetic pronunciation of your full name*

5. ADHD Crash Course was created to offer listeners free tools to manage ADHD. Both personal and professional insights are welcome. What topics are you interested in discussing?**

6. How would you like to be introduced? Feel free to include your professional background and/ or lived experience.*

7. At the end of your interview, I give business owners/ service providers a moment to share how they can be contacted and what they offer. Please include any links, freebies, websites, or offers you would like me to include in the show notes.*

8. I hereby grant to Clarity Coaching, LLC / ADHD Crash Course podcast the permission to record, use, publish, stream live, or otherwise distribute any audio or video derived from the interview with me. Such permission includes, but is not limited to, my name, recorded audio or video, photograph or likeness, biographical information I have provided, handouts or any material based on the interview.*

9. I understand that Clarity Coaching LLC/ ADHD Crash Course may produce publications based upon my audio or video interview that may appear in print, online, or other media, including promoting the podcast. I grant the ADHD Crash Course podcast the right to edit and/or transcribe my interview and waive any right of content approval /claims for compensation arising from the use of my interview.*

10. Please upload a headshot for use in media posts advertising our episode.*