MEDIA AND PROFESSIONAL INTERVIEW REQUEST Dr. Andy is taking requests for interviews, documentaries and related projects. He is supportive of individuals creating Freedom and Truth based media. Please fill out the below form and include all of the information requested in the provided fields so we may have all of the information we need to direct your New Interview Request. Forms that are not completed will not be considered. This form is for the person making the New Interview request for their own show. Do not fill out this form if you are not a person authorised to make such request. Confirmation* I Confirm I am the Person Authorised to Make Interview Requests Basic Contact DetailsName* First Last Email* Phone*What Time Zone are you Currently Located?*-Please Select-GMT Greenwich Mean Time GMTUTC Universal Coordinated Time GMTECT European Central Time GMT+1:00EET Eastern European Time GMT+2:00ART (Arabic) Egypt Standard Time GMT+2:00EAT Eastern African Time GMT+3:00MET Middle East Time GMT+3:30NET Near East Time GMT+4:00PLT Pakistan Lahore Time GMT+5:00IST India Standard Time GMT+5:30BST Bangladesh Standard Time GMT+6:00VST Vietnam Standard Time GMT+7:00CTT China Taiwan Time GMT+8:00JST Japan Standard Time GMT+9:00ACT Australia Central Time GMT+9:30AET Australia Eastern Time GMT+10:00SST Solomon Standard Time GMT+11:00NST New Zealand Standard Time GMT+12:00MIT Midway Islands Time GMT-11:00HST Hawaii Standard Time GMT-10:00AST Alaska Standard Time GMT-9:00PST Pacific Standard Time GMT-8:00PNT Phoenix Standard Time GMT-7:00MST Mountain Standard Time GMT-7:00CST Central Standard Time GMT-6:00EST Eastern Standard Time GMT-5:00IET Indiana Eastern Standard Time GMT-5:00PRT Puerto Rico and US Virgin Islands Time GMT-4:00CNT Canada Newfoundland Time GMT-3:30AGT Argentina Standard Time GMT-3:00BET Brazil Eastern Time GMT-3:00CAT Central African Time GMT-1:00 About You and Your Platform...What is the Official Name of the Show, Podcast or Platform?* Please Describe your Platform and the Content You Provide.*1000 CharactersYour Website / Platform URL* Please include a Link to Your Previous Shows or Interviews.Use this space to provide Dr. Andy with a clear example of your work, style and format. How Many Subscribers do You Have?*-Please Select-0-250251-500501-10001001-5,0005,001-10,00010,001-50,00050,001-100,000100,001,-250,000250,001-500,000500,001-1M1M+5M+10M+Are You Interested in Becoming an Affiliate of our Products and Live Events?*-Please Select-YesNoI would like more information About the Proposed Interview...Will the Interview Take Place Virtually or at a Physical Location?*-Please Select-VirtualPhysical LocationEitherVirtual Meeting Link If You Have a Meeting Link Prepared, Place it Here.Please Provide Intended/Proposed Location Details.* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country HiddenInterview Location: Copy Address HiddenAddress: What are the Proposed Topics of Discussion?*Please be as precise and concise as possible. If you have questions that you would like to ask then add them here too.Host / Co Hosts and GuestsPlease provide the Full Names of the Host any Guests or Co Hosts that will participate in the Interview. Any Further Information?Use this space to describe or propose any other ideas that you may have for the interview, collaborations and opportunities including any post-interview activities and any follow up interviews that may be required, for instance. Do You have a Specific Day, Date and/or Time for the Interview to Take Place?*-Please Select-No, This can be NegotiatedYesProposed Date MM slash DD slash YYYY Proposed TimePlease state the proposed time in US Eastern Standard Time (EST) UTC-5. : Hours Minutes AM PM AM/PM HiddenEntry Date MM slash DD slash YYYY CAPTCHAEmailThis field is for validation purposes and should be left unchanged.
