* 1. Provide your contact Information:

* 2. Please describe the topic of your story that you want to share

* 3. What is the title of your "talk"

* 4. Please list 3 questions that would be relevant to ask during our interview

* 5. Do you have a call to action, a website or a subscription service to point our audience to? 

* 6. Do you live in the Las Vegas area? 

* 7. Any additional comments that you would like to add?