01
CONTACT INFORMATION
First Name
Last Name
Email
*
Phone
*
Website
Instagram
Other Social profiles
02
YOUR STORY
What do you do, and who do you help?
*
What topic would you discuss on the show?
*
Why The McCord List Today specifically?
*
Book, product, program or service to highlight
03
YOUR AUDIENCE
Who do you serve?
*
Approximate Audience / Community Size
Primary Platform
Select one...
04
MEDIA EXPERIENCE & LOGISTICS
Previous TV or media experience *
*
Select one...
Comfortable on camera? *
*
Select one...
City / Location
Open to traveling to MBS Media Campus in Manhattan Beach, CA?
Select one...
05
AVAILABILITY & GOALS
General availability over the next 3–6 months
*
What's your main goal from appearing on the show?
*