Jackie B. Grice's Online Platform Guest Intake Form

Thank you for your interest in being a guest on Jackie B. Grice's online platforms. We are excited to learn more about you and explore the potential for collaboration. Please complete the following intake form:

Full Name

Phone

Organization/Company (if applicable)

Title/Role

Website (if applicable)

Instagram Handle

Facebook Profile

YouTube Channel

Which platform are you interested in participating in?

Lunch and Launch

Fireside Chats

Launching DeepHer

Briefly describe your area of expertise or the topic you would like to discuss on the platform

Have you been a guest on similar platforms or podcast before? If yes, please provide details:

Do you have access to a stable internet connection and a webcam for video presentation?

Are you comfortable with virtual platforms such as Zoom or similar for the online session?

Provide your general availability for the upcoming month:

Is there anything else you would like us to know or consider when reviewing your application?

Upload a photo (that would be displayed on marketing materials for any appearances on JackieB platform)

Upload Bio

Would you like to subscribe to receive updates?

Yes

Consent: By submitting this form, you agree to the terms and conditions outlined by Jackie B. Grice's online platforms and grant permission for the use of your name and likeness for promotional purposes related to the specific online session. Thank you for taking the time to complete our intake form. We will review your information and be in touch if there is a potential match for collaboration on Jackie B. Grice's online platform.

Jackie B. Grice's Online Platform Guest Intake Form

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