Be Our Guest

PsychedelicIQ Podcast Guest Application

Thank you for considering speaking on the PsychedelicIQ podcast.

Here are the steps to become a guest on the podcast:

Complete the form below. This should be done from the perspective of offering practical and grounded wisdom for psychedelic practitioners – not psychedelic clients.
After reviewing your submission, we will send you an email to schedule a 20-minute “get to know you” call to discuss your interview.
After your discovery call, you will receive a second email with a link to schedule your 60-minute interview.

Speaker Bio & Release

Will you be using your real name or an alias?

Guest First Name *

Guest Last Name *

Guest Alias

Email *

OK to publicize your email? *

Phone Number *

OK to publicize your phone number? *

Your Website URL

Your LinkedIn URL

Your Instagram URL

Your Facebook URL

Your Bio (500 words or less) *

Upload Your Headshot *

Maximum upload size: 5MB

Please ensure your image is at least 500x500 pixels, in JPG or PNG format, and smaller than 5MB.

Please list at least three potential topics you'd like to discuss your episode. *

Please list at least three question's you'd like to be asked during your episode. *

Please list any topics or question you would not like to discuss.

Are there any articles, books, or content you've created that we should read prior to your interview?

If you have a free gift or piece of content you'd like to share with our listeners, please paste the URL here.

Is there anyone in your network or community you think we should interview for the podcast?

Release

     I, the above-mentioned Guest, do hereby consent to the recording, transcription, or reproduction(s) of my voice, words, likeness, ideas, and music (herein referred to as “Content”) as part of the PsychedelicIQ Podcast (herein referred to as "Program").
     I hereby acknowledge that Pure Imagination, LLC dba PsychedelicIQ (collectively “Producers”) is the sole owner of all rights in and to the Program, Content, and derivative works thereof, for all purposes; and have the right, among other things, to distribute, reproduce, transcribe and republish the Program and Content one or more times by any medium or mode of transmission whatsoever. Any materials relating to the production and distribution of the Program and Content become property of Producers. I further acknowledge and agree: 
     (a) I will receive no compensation for appearances on and participation in Program. I also agree I will receive no compensation from any further distribution, reproduction, transcription or republishing of the Program, Content or derivative works. 
     (b) I understand my name and likeness may be used in advertising and promotional material for the Program, but not as an endorsement of any product or service. 
     (c) I hereby releases and discharges Producers together with all of Producer’s principals, shareholders, officers, employees, agents, successors, heirs, assigns and affiliates from any and all liability arising out of or in connection with the making, producing, reproducing, processing, exhibiting, distributing, publishing, transmitting by any means or otherwise using the above-mentioned Program or Content.

Address (so we can send you a gift)

Address Line 1

City

State/Province

Zip/Postal

Country

Signature *

Guest's Full Name

Date *

Signed This Date

Captcha

If you are human, leave this field blank.