Guest Intake Form

About the show: Gather around our virtual campfire to hear the stories of purpose-driven people doing good in the world. All of us have “WOW” moments that change our thinking, force us to pivot our approach, or simply wake us up. In “Change, From the Top”, we’ll meet change agents, entrepreneurs, and big thinkers, to learn about their “WOW” moment and how it got them to where they are today. We’ll explore how financial wellbeing contributes to mental and physical health, how people are championing the movement toward more diverse, equitable, and inclusive workplaces, and how everyday people build financial resilience in their own lives.

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How would you like to be credited on the show & in promotional materials?

(ex. Founder of [ Company ], Creator of [ Program ] or Author of [ Book Title ])

Preferred Social Media Profiles (URLs)

Preferred Bio

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Is there anything else you think we should be aware of prior to our interview?

Media Waiver

This form is an important legal document. It explains the terms of agreement for participating as a guest on the Working on Wellbeing Podcast. It is important that you read and understand it completely. After you have done so, please select "I accept".

Salary Finance Inc and its affiliates, agents, and successors have the right and permission to record, use, publish, stream live, offer for sale, or otherwise distribute any audio or video interview and/or session with me. Such right and permission includes, but is not limited to, my name, recorded voice or video, photograph or likeness, professional and/or personal, biographical information, handouts or any material based upon or derived therefrom, in perpetuity in any medium or format whatsoever now existing or hereafter created, and for any purpose.

I understand that Salary Finance Inc may, at its sole discretion, produce presentations or publications based in whole or in part upon audio interview (or any portions thereof) and/or a video or audio recordings or photographs of said interview, and that such media or transcripts may appear in print, online, or in any manner or media, including but not limited to promoting the podcast, for marketing purposes generally promoting Salary Finance Inc or its affiliates, or streaming audio program. Salary Finance Inc's Working on Wellbeing podcast shall have the right to edit and/or transcribe your session and/or interview.

I have no right of review or approval, no claim for compensation, and no claim (including, without limitation, claims based upon defamation) arising out of or in connection with, any use, alteration, or use in any composite form hereunder. I hereby release and discharge Salary Finance Inc together with all principals, shareholders, officers, employees, agents, successors, heirs, assigns and affiliates from any and all liability arising out of or in connection with the program, the session, the making, producing, reproducing, processing, exhibiting, distributing, publishing, transmitting by any means or otherwise using the above mentioned production. I hereby agree not to make or bring any such claim against any authorized persons.

I hereby warrant and represent that I have the right to enter into this agreement and to grant the rights granted to Salary Finance Inc. I agree that during the course of the interview and/or session I have not violated the rights of any third parties, including but not limited to copyrights, rights of privacy, trade secrets, and non-disclosure agreements, and that in the event of any breach of any of these warranties, that I will defend and hold Salary Finance Inc harmless against any such claim.

This release is binding for me and my heirs, legal representatives, and assigns. I am acknowledging full agreement to all terms, and understand that I am agreeing to grant these rights and permissions to Salary Finance Inc.

I understand Salary Finance Inc is relying on this Agreement and will incur significant expense in reliance on this Agreement, and I agree this Agreement cannot be terminated, rescinded or modified, in whole or in part.

This Agreement constitutes the sole and entire agreement of the parties with respect to the subject matter contained herein and supersedes all prior and contemporaneous understandings, agreements, representations, and warranties, both written and oral, with respect to such subject matter. I have not relied on any statement, representation, warranty, or agreement of Salary Finance Inc or of any other person on Salary Finance Inc’s behalf, including any representations, warranties, or agreements arising from statute or otherwise in law, except for the representations, warranties, or agreements expressly contained in this Agreement. If any term or provision of this Agreement is invalid, illegal, or unenforceable in any jurisdiction, such invalidity, illegality, or unenforceability will not affect any other term or provision of this Agreement or invalidate or render unenforceable such term or provision in any other jurisdiction. Salary Finance Inc may assign this Agreement and its rights hereunder, in whole or in part, to any party. This Agreement is binding on and inures to my benefit and the benefit of Salary Finance Inc and our respective heirs, executors, administrators, legal representatives, successors, and permitted assigns. All matters arising out of or relating to this Agreement shall be governed by and construed in accordance with the internal laws of the State of Massachusetts without giving effect to any choice or conflict of law provision or rule (whether of the State of Massachusetts or any other jurisdiction). Any claim or cause of action arising under this Agreement may be brought only in the federal and state courts located in Boston, Massachusetts, and I hereby irrevocably consent to the exclusive jurisdiction of such courts.

Execution of this Agreement does not obligate Salary Finance Inc to broadcast or publish your session or other materials.

THIS AGREEMENT PROVIDES COMPANY WITH YOUR ABSOLUTE AND UNCONDITIONAL CONSENT, WAIVER, AND RELEASE OF LIABILITY, ALLOWING COMPANY TO PUBLICIZE AND COMMERCIALLY UTILIZE YOUR NAME, LIKENESS, AND OTHER PERSONAL CHARACTERISTICS AND PRIVATE INFORMATION AS SET OUT ABOVE. BY SIGNING, YOU ACKNOWLEDGE THAT YOU HAVE READ AND UNDERSTOOD ALL OF THE TERMS OF THIS AGREEMENT AND THAT YOU ARE GIVING UP SUBSTANTIAL LEGAL RIGHTS, INCLUDING THE RIGHT TO SUE COMPANY.

Do you accept the terms of this media waiver?(Required)