Books of the Month Show Updated

Name *

Stage Name ( if applicable)

If you are a publishing company or agent? Please provide us with the name of your company, contact person and phone number. *

Mobile Phone Number *

Best time of day for a pre-interview via phone *

Morning 9:00 - 12:00 Noon

Afternoon 12:00 noon - 5:00 pm

Evening 5:00 - pm - 9:00 pm

Title of Book and brief summary of the book *

Guest Appearance Preference *

I will come to the TV Studio

I prefer Remote from my home or office ( some shows require TV studio, we will advise)

Do you understand that you will be approved to be a guest on this show, based on the information provided and confirmed. If you are not approved, we will contact you with information as to why you were not approved. You also agree that the information you provide us on this form is accurate and of truth. *

Yes

Email Address *

City and State *

How did you hear about us? *

Tell us about yourself, book title and summary of the book. *

Would you be interested in a presentation on how you can have your own TV Show on our network? *

Yes

Do you understand this broadcast is supported by our TV advertisers and they make it possible for us to continue broadcasting our featured TV Shows on PTWWN TV. We ask guests to participate in our ad campaigns by listening to a brief presentation about the products or services of our advertisers. You are under no obligation to make any purchase unless you choose to at your free will. Do you agree to participate in the no-obligation ad campaigns that will take around 15 minutes of your time. *

Yes

TV Release RELEASE FORM - You grant PTWWN Broadcasting and its affiliate channels permission to film you as a guest on one of our flagship TV shows. You also grant us permission to use your likeness, images and video clips for promotional and publicity purposes on our television network, affiliate channels, social media, websites, etc. You understand that there is no compensation as a guest on the television show. You also agree that there is no travel allowance unless it is in writing signed by the executive producer. We hold the rights and licensing of this television show and have the right to rebroadcast the show more than once. *

Yes

No ( your application will be denied if you select no)