MomTalkRadio Mom's Roundtable
Exit this survey

1. MomTalkRadio Mom's Roundtable

Interested in being a guest on the Mom's Roundtable on MomTalkRadio? We need you!

MomTalkRadio, the #1-downloaded parenting podcast hosted by Maria Bailey, includes a portion of the show called the "Mom's Roundtable". The roundtable involves two moms chatting with show host, Maria Bailey about a variety of topics, from creative staycations to potty training and any subject in between. The segment takes approximately 10 minutes via a phone call (a show producer calls you). The show is taped. If you are interested in being a guest for the Mom's Roundtable discussion, please fill out the information below. Be sure to include all of your contact numbers. If you are chosen, the show producer will confirm dates and times in advance to allow busy moms to plan accordingly! Thanks, and we look forward to hearing from you!

*
1. First and Last Name

First and Last Name

*
2. Landline Phone Number:

Landline Phone Number:

*
3. Cell Phone Number (as backup):

Cell Phone Number (as backup):

*
4. Email Address

Email Address

*
5. Blog Name (if applicable)

Blog Name (if applicable)

*
6. Blog URL (if applicable)

Blog URL (if applicable)

7. Twitter ID (if applicable)

Twitter ID (if applicable)

8. How many children do you have?

How many children do you have? 1

9. Please indicate children's ages:

Please indicate children's ages: 0-2

3-5

6-8

9-12

13+

10. Do you have topic suggestions for the Roundtable? List them here:

Do you have topic suggestions for the Roundtable? List them here:

MomTalkRadio Mom's RoundtableExit this survey

1. MomTalkRadio Mom's Roundtable

*1. First and Last Name

*2. Landline Phone Number:

*3. Cell Phone Number (as backup):

*4. Email Address

*5. Blog Name (if applicable)

*6. Blog URL (if applicable)