What is your email address?

Your preferred name for the podcast (i.e. the full name you want to appear on marketing and in the shownotes)

Your age (decade is fine!)

How did we meet?

If selected other, please specify. Otherwise, fill in N/A

What is your occupation?

What topics would you like to discuss on the podcast?

Are there specific questions you'd like me to ask during our interview?

Are there any accommodations you'd like me to make prior to or during our recording?

Please provide a short bio that can be used in the podcast introduction and shownotes.

Please share any links you would like to appear in the shownotes.

Do you have a podcast? If so, would you be open to a "podcast swap"? Otherwise, fill in N/A.

Please upload your headshot that will be used for the podcast cover art.