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

Comfortable on camera?

Select one...

Previous TV or media experience *

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? *