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Participation Registration Form

Thank you for your interest in participating in our talk show! Please complete this form to provide the required information. Your participation will be featured on YouTube, Instagram, TikTok, and other platforms. Kindly ensure to enter all details accurately in order to avoid any processing delays.

Participant Details:

Name/Business Name

Contact Person (for businesses)

Phone Number

Website/Social Media Handles:

Intagram

Tik Tok

YouTube

Participation Details:

Preferred Topic/Area of Expertise

Proposed Date(s) for Appearance

Do you have any special requirements (e.g., technical setup, accessibility needs)?

Do you consent to being recorded and having your appearance distributed across social media platforms (YouTube, Instagram, TikTok, etc.)?

Yes No

How did you hear about the show?

Social Media Recommendation Other:

Media Distribution and Advertising :

Key clips and promotional pieces from your appearance will be advertised on Instagram, Facebook, and TikTok for two consecutive weeks following the recording date. The full episode will be uploaded to YouTube and remain available for a minimum of 1 year or for the entire duration of YouTube’s existence, whichever is longer. By signing this form, you acknowledge and consent to this distribution and advertising strategy.

Terms & Conditions :

Participation Agreement:

1. A non-refundable deposit of 50% is required to secure your spot and cover costs for the recording crew.

2. The remaining balance must be paid 7 days prior to the scheduled recording date.

3. The organizer reserves the right to modify the schedule if needed.

4. All content recorded during the show remains the property of the talk show.

5. Participants must adhere to the scheduled timing and format agreed upon.

Penalties for Non-Compliance:

1. Failure to pay the remaining balance by the deadline will result in cancellation of your booking with no refund of the deposit.

2. Cancellation by the participant within 5 days of the agreed date will result in a loss of 100% of the deposit.

3. Cancellation within 48 hours of the agreed recording date will result in no refund of deposit fee and a penalty of $1,000.00

4. Non-compliance with agreed terms may result in a penalty fee of $3,000.00.

Consent to Share Information:

By checking this box, you agree to allow your details, as provided, to be used for the purposes of promoting your appearance on the show.

PARTICIPANT RELEASE AND WAIVER AGREEMENT :

This Participant Release and Waiver Agreement (“Agreement”) is
entered into as of the date signed below by the undersigned participant
________________________________(“Participant”) in
connection with their participation in the talk show produced by
ConnAction Network, Inc. (“Producer”).

Grant of Rights
Participant irrevocably grants to Producer, its affiliates, successors, and
licensees the following rights:
a. The right to record, film, photograph, or otherwise capture
Participant’s voice, likeness, image, name, and performance (the
“Recordings”).
b. The exclusive, worldwide, and perpetual right to use, reproduce,
distribute, broadcast, display, edit, modify, or otherwise exploit the
Recordings, in whole or in part, in any format or media now known or

hereafter devised, including but not limited to television, radio, online
platforms, and promotional materials.
c. The right to use Participant’s name, likeness, and biographical
information for promotional and commercial purposes in connection
with the talk show.

Waiver of Claims
Participant hereby releases and forever discharges Producer, its
officers, employees, agents, and affiliates from any and all claims,
demands, damages, or causes of action arising out of or in connection
with Participant’s participation in the talk show, including but not limited
to:
a. Claims of defamation, invasion of privacy, or infringement of publicity
rights.
b. Any alterations or editing of the Recordings that may appear
unfavorable or objectionable to Participant.
c. Any injuries, losses, or damages incurred during or as a result of
participation in the talk show.
Assumption of Risk
Participant acknowledges and agrees that participation in the talk show
is voluntary and may involve inherent risks. Participant assumes all
risks associated with their participation and releases Producer from any
liability for injury, illness, or harm arising from their participation.
Confidentiality
Participant agrees not to disclose or discuss any confidential or
proprietary information related to the talk show, including but not limited

to production details, show content, or any information about other
participants, without prior written consent from Producer.

No Compensation
Participant acknowledges that they are participating in the talk show on
a voluntary basis and will not receive any monetary compensation,
unless otherwise agreed upon in writing.
Governing Law and Dispute Resolution
This Agreement shall be governed by and construed in accordance
with the laws of the State of Florida. Any disputes arising under this
Agreement shall be resolved exclusively through arbitration in Miami,
Florida, and the decision of the arbitrator shall be final and binding.
Entire Agreement
This Agreement constitutes the entire understanding between the
parties regarding the subject matter herein and supersedes all prior
agreements, whether oral or written.

By marking the check box, Participant acknowledges that they have read, understood, and voluntarily agree to the terms and conditions of this Agreement.