Podcast Guest Information Hi!! We are so excited to have you as a guest on The Neon Lounge! Please fill out this short questionnaire so we have all the information we need to make the episode amazing ⚡️ Name * First Name Last Name Your preferred pronouns * Email * Phone * (###) ### #### Address Address 1 Address 2 City State/Province Zip/Postal Code Country 3-5 bullet points of achievements or talking points you would like to go over in the recording * Any areas you do not wish to talk about (personal life, relationships or specific topics) Any accessibility requirements (for the recording, but also because we are planning an event and you’re invited!) A short bio (approx 100 - 150 words) * How you wish your name and job title to appear * Link to your LinkedIn profile http:// Link to your website (if applicable) http:// Professional Instagram (if applicable) http:// Diversity, Equality and Inclusion (DEI) Monitoring What gender do you identify with? * Male Female Other I prefer not to say What is your age? * 16-24 25-34 35-44 45-54 55-64 65-74 75+ Do you have any physical or mental health conditions or illnesses lasting or expected to last 12 months or more? * Yes No I prefer not to say Please choose one of the following options that most accurately describes your ethnic group or background * English/Welsh/Scottish/Northern Irish/British Irish Gypsy or Irish Traveller White and Black Caribbean White and Black African Asian / Asian British Black African/Black Caribbean/Black British Arab I prefer not to say Sexual orientation * Bisexual Gay or lesbian Heterosexual Other I prefer not to say Religion or belief * No religion or Atheist Buddhist Christian Hindu Jewish Muslim Sikh Other I prefer not to say Main residence * North East North West Yorkshire and Humberside East Midlands West Midlands East London South East South West Wales Scotland Ireland Outside the UK Other I prefer not to say Thank you!
