Guest Release

Terms and conditions

I have read and agreed to the Terms of service *

I have read the consent and release form (link above), I fully understand it, and I agree to be bound by it. I represent and certify that my true age is at least 18 years old, or, if I am under 18 years old on this date or otherwise unable to enter into this agreement on my own, my parent or legal guardian has also signed below.

Participant Details

Full Name

Mobile

Email

Address

Address Line 1

City

State

Zip Code

Podcast name Email

18 year confirmation

I am under 18 years of age

Podcast Details

Why do you want to record with Last Words?

Provide a brief explanation on why you want to have your last words recorded.

Personal Photos

Drag & Drop Files, Choose Files to Upload You can upload up to 5 files.

Attach 3-5 pictures of you and your family members for Last Words to use as the feature images for your podcast episode.

Proof of diagnosis

Drag & Drop Files, Choose Files to Upload

Last Words requires proof of diagnosis before we scheduling a recording. Please contact your primary physician for documentation and attach it here

Projected life expectancy (if applicable)

Selected Value: 1

months

Participant signature

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Signature date

Last Words, LLC: Guest Release

Participant Details

Podcast Details