SUBMITTER DETAILS

First Name *

Last Name *

Email *

Phone *

WHO IS PARTICIPATING?

PARTICIPANTS' REAL NAME *

PARTICIPANTS' STAGE NAME

Where is the video participant located (include City, State, and Country)

Click here only if you are appearing in another person's video to provide acknowledgment, context, or testimonial value.

SOCIAL MEDIA

List only the accounts that you will want to public to see

Facebook Page

Instagram Page

Youtube Link

Twitter

Other

Would you like for us to collaborate or tag you on social when the video is released?

Yes

B-roll

B-roll is footage that we will use to supplement the main video footage. We use it to help establish a scene, smooth out a scene, or add meaning.

You may have videos, pictures, audio, or ariel footage on hand that can help to tell and give context to your story. It’s very important for you to provide us any footage that you own or have access to.

We need to collect this footage ahead of time as it helps us to frame the interview and better tell your story. To avoid copyright infringement, it also very important to give credit to and get permission from the person/company that produced the footage if you do not own the legal rights to it.

Please upload and attach all your B-Roll content to an accessible Google Drive, WeTransfer, Dropbox, etc. cloud drive link and list below. In the text box, please give a short description of each attachment and indicate who the owner of the material is. If you are copying a social media link into the text box, we will attribute the content to the person's social media handle, unless you tell us different. We recommend that you compile all of your files first before uploading them or pasting in the links.

Please provide accessible drive links with any uploaded B-roll footage you have:

If you have social media or bio links that explain more about you or your company, please paste the link(s) to the information.

Please give a short description of each attachment and indicate who the owner of the material is.

Alternatively, please provide attachments for any B-roll or Bio footage that you have. (50MB limit)

UPCOMING FEATURES AND NETWORKING

Upcoming Features

In the “Your Works and Image” section above, you will find the feature categories for our channels. Do you know of any other extraordinary people who have ideas or experience worth sharing? If so, please list their names and what they do. If you have their social media information, please share it and we will check them out and circle back to you for more information.

Special Projects

We are currently working on a segment which features seasoned, small business owners with 2-5 million in revenue per year. If you know of business owner that falls in that category, please list the owner’s name and business below.

CONCENERGY Worldwide

I would like to attend 2027 CONCENERGY Worldwide.

CONSENT & AGREEMENT

I affirm that I am either more than 18 years of age or an emancipated minor, or possess legal parental or guardian consent, and I am fully able and competent to enter into the terms, conditions, obligations, affirmations, representations, and warranties set forth in these Terms and Conditions. I confirm that I represent the participant above and that I have permission to use all documents or media that has been submitted.