check

Radio Show Questionnaire

Propose Your Radio Show to be on Break Free from the Burnout with Dr. Anastasia Chopelas.  If you've already spoken with me, please fill in the form: you are already approved.  

Click the button to get started.

Start

Question 1 of 10

Enter Your Name

Question 2 of 10

Enter Your 200 word biography

Question 3 of 10

Upload a minimum of 1400x1400px photo of yourself.

file_upload
insert_drive_file

Question 4 of 10

Proposed interview topic.  Remind me here, if we've already spoken.

Question 5 of 10

URL of free offer to audience, if any.  Otherwise write none.

Question 6 of 10

Your website URL.

Question 7 of 10

Questions Anastasia could ask you, up to 6.  If the standard set of questions work for you, write none.

Question 8 of 10

Social media url's, if you have accounts, including Facebook, Twitter, Instagram, etc.  Ex: http://twitter.com/anachopelas, so I can cross promote you.

Question 9 of 10

Your best phone number to reach you in case something goes wrong.

Question 10 of 10

How are you going to promote your show?

A

Mail my list

B

On at least 2 social media platforms

C

Both

Confirm and Submit