Mom's Roundtable Application

1. Are you interested in participating in the Mom Talk Radio Mom's Roundtable?

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 is taped and takes approximately 10 minutes via a phone call (a show producer calls you).

If you are interested in being a guest for the Mom's Roundtable discussion, please fill out the information below. If you are chosen, the show producer will reach out to you via email to confirm a date, time and topic of discussion for recording.

We look forward to having you on the show!

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* 1. First and Last Name

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* 2. Phone Number:

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* 3. Email Address

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* 4. Blog Name (if applicable)

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* 5. Blog URL (if applicable)

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* 6. Twitter ID (if applicable)

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* 7. How many children do you have?

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* 8. What are your chilren's ages?

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* 9. What topics are you comfortable participating in a discussion about? List as many as you would like!