TCT Guest Information

Contact and CG Graphics

Today's Date(Required)

Name(Required)

First Last

Phonetic Spelling / Pronunciation of Your Name (Example: Alphabet = al-fuh-bet)(Required)

Ministry/Group Name(Required)

Mailing Address(Required)

Street Address Address Line 2 City State ZIP Code

Physical Address (If different than Mailing Address)

Street Address Address Line 2 City State ZIP Code

Business Phone(Required)

Cell Phone(Required)

Website(Required)

Email(Required)

List any social media information you would like included(Required)

Are you promoting a Book?(Required)

Yes

If yes, Title of Book

On-Screen Graphics (Example: John Doe - Missionary to Africa)

Name(Required)

First Last

Title

Do you want your website put on the screen graphics?(Required)

Yes

Website

Do you want your Ministry/Business Name on-screen?(Required)

Yes

Ministry/Business name

Guest Confirmation Release(Required)

I accept your invitation to participate in production of the “Program” specified below and hereby specifically authorize you (and your affiliated media distribution systems) to use my name, likeness, biographical information, voice and visual performance in the distribution of the Program, and for any promotional, advertising, or other marketing use that you may deem appropriate. I further authorize you to edit, air and reuse the Program, in whole or in part, as you deem appropriate for distributing via radio, television, satellite, microwave, cable, internet, close circuit exhibition or any other form of electronic or mechanical means throughout the world. I also agree, if by reason of my statements and/or actions on the Program or by materials furnished by me for the Program, a third-party claim, demand or suit for violation or infringement of rights and/or damages arises in connection with distribution of the Program, to hold you (and your affiliated media distribution systems) harmless from any liability, loss or expense incurred due to said claim, demand or suit.

Name of Program You Are On(Required)

Taping Date(Required)

Main Topic for Discussion(Required)

Please list at least 4 questions or talking points to be asked of you by the host.

Talking point/Question Number 1(Required)

Talking point/Question Number 2(Required)

Talking point/Question Number 3(Required)

Talking point/Question Number 4(Required)

This field is for validation purposes and should be left unchanged.