subject_line
Name (Please include your title if you desire to be addressed as such.)
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Todays Date
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Email Address
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Phone Number
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City
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State
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Zip Code
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Select the show that you would like to be a guest on
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Shekinah Women of Beauty Show
Books of the Month Show
Preach The Word Show (preachers only)
Americas Got Anointing ( Gospel Showcase)
The Holy Wed Show
Men with Vision
Real Life Issues with Lois Lane, ( Let God be your Superman)
How did you hear about us
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Personal Invitation
Facebook
Twitter
Instagram
Linkedin
Craigslist
Referral
Other ( please list)
Would you like to participate as a special guest at our studio (Peach tree Corners, GA.- Atlanta Metro GA) or remotely from your home or office?
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TV Studio Taping (I understand PTWWN is not responsible for any of my hotel, travel, food, or miscellaneous expenses)
Remote Taping
Our TV shows are sponsored by our advertisers. Do you agree to participate in our ad campaigns to listen to a brief presentation of their products and services with no purchase obligation.
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Yes
No
If this is a studio taping, will you invite guests to join the studio audience?
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Yes
No
If yes, how many? (estimate)
If yes, how many? (estimate)
Musicians are allowed only on the Preach The Word Show. We have a piano/keyboard available for you in the studio.
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Yes I will be bringing a musician ( Preach the Word Show only)
No
I am not sure yet
Does not apply to me because I will be on another TV show.
Please share a brief description of yourself and what you would like to discuss on the show.
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Are you an author or business owner, and would you like information on special TV advertising rates to promote your book, product or service on our network?
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Yes
No
PTWWN Broadcasting Inc. RELEASE AGREEMENT I grant PTWWN and its affiliate network channels permission to broadcast my TV appearance on all platforms. ( network channels on broadcast TV, cable TV, online video platforms live or on-demand, social media, or any other video or TV distribution platforms.) I agree that my guest appearance participation is at the sole discretion of PTWWN. I consent to the use of my name, likeness, voice, and biographical material and information about me in connection with the picture or video publicity and related promotional purposes. I expressly release PTWWN Broadcasting Inc, its agents, employees, licensees, and assigns from and against all claims that I have or may have for invasion of privacy, defamation, or any other cause of acting out of production, broadcast, or exhibition of the TV show. I voluntarily release PTWWN from all liability and hold PTWWN harmless from all risks while in attendance at PTWWN Broadcasting Studios. By selecting Yes and signing this agreement form, I agree to the above aforementioned.
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Yes
No
I understand this is my official TV Show booking agreement, and I agree to all terms and conditions. I will receive an official confirmation to confirm the day, date, and time of the television taping. If I do not receive it within 72 hours, I am to call 404 836 3838 ext. 1003
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Yes
No
Have you been on any of our TV Shows in the past? If yes, what show?
Signature
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