realitytrip+podcast.jpg
 

REALITY TRIP WITH BEN FAMA JR.
GUEST CONTACT FORM

Thanks for your participation in our show! Since we have a live video broadcast, our goal is to have the best broadcast possible.  Your input below will greatly help to make that happen. If you need to check your internet speed, you can visit speedtest.net

Near the day of the show, we will send you a link to join the show by video by e-mail.  You can use your browser or mobile phone for the video link.  Google Chrome on desktop works best.  We will do a video and audio test before the live broadcast to ensure your equipment works.

For the best quality, have good visible light (either natural or with artifical) and be in an environment with minimal noise. Please let us know if you have any questions!

 
Info
In order to have the best broadcast possible, please fill out the information below.
Name *
Name
Please provide a short bio or introduction on how you would like to be introduced.
If unknown, please visit speedtest.net to check speed.
If unknown, please visit speedtest.net to check speed.
Do you have a microphone? *
Promotion
Please let us know how we can promote you
http://
If you have a product or service (such as a book, film, etc) on Amazon, please provide the product name listed. If you don't have one, just leave blank.
PERSONAL RELEASE
I agree to appear and to be film and/or videotaped in connection with the above-referenced Program. You and your subsidiaries, successors, licensees and assignees may copyright, use and reuse, publish, distribute, edit, excerpt, exhibit, and otherwise exploit my name (real or fictitious), likeness, persona, performance, voice, pictures, biographical information and identification, and statements (collectively, my "Appearance"), for any and all uses, in whole or in part, in any and all media and manners, for the Program or any other program, throughout the world in perpetuity and without limitation, including in connection with the advertising, exploitation and publicizing of the Program or any other program. You shall own, and I grant and assign to you, all right, title and interest of every kind and character in perpetuity throughout the universe, in and to, the Program and the result and proceeds of my Appearance, all of which are works made for hire, specially commissioned for use as part of an audiovisual work, including all copyrights, renewals and extensions of copyright, and you shall be deemed the author thereof for all purposes. You may edit my Appearance as you see fit, and I understand that you have no obligation to use my Appearance. I am aware that a still photographer also may be present during the dates of performance, and I grant you and your successors, licensees and assignees the right to copyright and use said photographs without further payment to me in printed publications, or any other media, without restrictions. You shall also have the right, and I shall fully cooperate with you, to let you to produce, distribute and otherwise exploit trailers and "behind-the-scenes" or "making of" programs incorporating my Appearance. I hereby release and discharge you and your successors, licensees and assignees from any and all claims, demands, or causes of action that I may have, whether for libel, violation of my right of privacy or publicity, or any other matter arising out of, or in any manner connected with, the use of my Appearance or the exercise of the rights granted herein. I hereby verify that all statements and other information given by me are true and accurate, and I agree to be legally responsible for any claims arising from such statements. I acknowledge and agree that this release shall not be subject to the terms of any union or guild agreement and that no sums will be due to me in connection with the use or reuse of my Appearance, the Program or any other program in television or in any other medium. I understand that you are proceeding in reliance upon the terms set forth herein, and I will not attempt to revoke this release at any time. I have carefully read the terms of this release and in consideration of your considering the use of my Appearance in the Program, have indicated my understanding and agreement by signing below.
Please type your name to agree.