The Power of Crappertunity - Documentary Participation Application

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Date* This field is requiredToday's Date
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Day
Date
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Full Name* This field is required
First Name
Last Name
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E-mail* This field is required
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Phone Number* This field is required
Area Code
Phone Number
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5
Your Website* This field is required
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6
Tell us about a challenge you have faced. How it was, what changed, what you learned, and how life is different now.* This field is required
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What was the biggest challenge you faced during this situation?* This field is required
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On a scale of 1-10 (10 being highest) how big of a part did this situation play in taking you to where you are in life or business today? Explain.* This field is required
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What habits or counterproductive behaviors did you have while experiencing the situation?* This field is required
Denial
Deflated Ego
Inflated Ego
Disavowal
Numbing
Dissociation
Blame
Victimization
Isolation
Finding People to Agree with Negativity/Bad Behavior/Ideas
Hopelessness
Powerlessness
Inaction
Reaching for a Miracle
Giving Up
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10
Would you be interested in your story being part of a book on how to turn challenges into opportunity? Why or why not?* This field is required
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Would you be interested in telling your story on a radio show? Why or why not? (Interviews to air live on KNVC 95.1 Carson City and syndicated via public radio exchange - Station branded blog with audio provided)* This field is required
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What would it mean to you to be able to help others with your story?* This field is required
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13
Would you be willing to be part of the launch of this project? If so, please list below number of people you have following you on LinkedIn, Facebook, Instagram, Twitter, and/or subscribed to your email list as well as any other opportunities you would have in 2019/2020 to co-promote.* This field is required
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14
I certify I am located in Los Angeles or willing to travel there at my expense if I am chosen to participate in the documentary.* This field is required
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We’ll contact you in the next 2 business days to let you know if you pass pre-screening. We will invite you to produce a two-minute audition video if you qualify. Or, if you really want to stand out from the crowd – UPLOAD YOUR AUDITION VIDEO NOW AND TELL US WHY YOU WANT TO BE PART OF THIS PROJECT.
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