The Lorne Epstein Show Guest Survey This form is only for booked guests of the Lorne Epstein Show. If you wish to be a guest on one of our upcoming shows please contact us via the form on our contact page. Name* First Last Email* LinkedIn Profile Twitter HandleYour Bio*80 Words MaximumProfile Photo UploadAccepted file types: jpg, gif, png.jpg, gif or pngIf there is a preferred Monday in the future you would like your show to air, please enter it here; By signing the form below, I grant to WERA, Lorne Epstein, and Electric Cow (and affiliates, licenses, partners and assignees) the right to use, reuse, publish, broadcast, electronically post and otherwise disseminate my name, photograph, and any audio recordings, content, video recordings and/or photographs made during today’s interview. I release WERA, Lorne Epstein and Electric Cow (and affiliates, licenses, partners and assignees) from any and all claims, demands or causes of action that I might assert in connection with the above as long as there are no misrepresentations of the interview. By giving my permission, I do not give up any copyright or performance rights I may hold.Release Form* I agree. Date* Digital Signature*Please enter your full name.NameThis field is for validation purposes and should be left unchanged. Submit This iframe contains the logic required to handle Ajax powered Gravity Forms.