Your Name (required):

Your Title:

Business Name:

Website/blog (URL):

Phone Number (required):

Your Email (required):

Twitter Handle:

Facebook Page URL:

Linkedin URL:

Are you on Periscope? YesNo
If yes, what's your handle? Number of followers?


What is your area of expertise?

Brief Bio (50 words or less):

If you've authored a book, the title:

and a link to the book's site/page:

What show topic or theme could you suggest that would shine a light on your expertise?

What is your Vision?

What are the key talking points that you’d like to share with women entrepreneurs?

Special Promo or Offer
If there is a special offer you'd like to promote, please list details here. We may share the information in our newsletter or do a promotional plug during the show.

Will you promote your guest appearance on the show via social media and on your website?
YesNo

If yes, total # of followers/fans/connections:

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Attach a head shot (jpg only, 5MB size limit). Your Bio & head shot will be used to promote you as the “Visionista of the Week” on the Million $ Party Girl Facebook page. I’ll tag you so you can share the link love via your social sites.
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