CHI Podcast Application

Full Name*

Your Cell Phone *
In case we have emergencies or tech issues

Your E-mail*
(Booking notifications and Interview Connection Instructions will be sent to this email. Please Note - This is a VIDEO recording over Zoom.)

Website*

Proposed Title of Podcast*

Bio*

What is your Mission? (in 50 words or less)*
For ex. My mission is to awaken women leaders to ignite their purpose & inner beauty via hormone harmony, toxin cleansing & trauma clearing.

Podcast Questions: Please list 6-8 questions you'd like me to ask you during our podcast, in order of preference*
Heads up: The first question I will ask you is 'What is your Definition of Beauty'?

Upload Your Professional Headshot (Landscape Please)*

What kind of program, products or solutions would you like us to reference on the show to promote you and your efforts?*
If you wrote a book you would like us to read, please provide the link here for us to download.

If you have an affiliate program, please indicate it below.*
Do you have an affiliate program you'd like us to use to support/promote you? If so, please provide the link to register here.

Would you like to offer a Coupon Code or Promo to our Tribe? (YES/NO) *
If YES, please type coupon amount (ie 10% off, $10 off), and code you would like to create for us (DRDIANE suggested)

Please enter the link where we can download/share your FREE Gift, if applicable.*
Do you have a FREE Gift you would like to give to our Listeners?

How will you share this episode with your tribe? We would love a mention to your email list (preferred). Plan for an email? Social media/Story post?*
We will email all of our show assets within one month after our recording.

Anything else you would like us to know? ...such as why you’re excited to be on our show? 😉

I confirm that I wish to receive content from CHI Holistic Health Ministry PMA using the contact information I provide below. I acknowledge membership to this PMA is complimentary, and as a member of CHI Holistic Health Ministry PMA, I will enjoy all of the benefits of our Private Ministerial Association, Private Healing Association and Private Education Association. All of your activity and information is private and will never be release to any PUBLIC authority.