be on the show

Name *

First

Last

Phone *

Email *

Address *

Enter your full address

Instagram *

https://instagram.com/USERNAME

Twitter *

https://twitter.com/USERNAME

Facebook *

https://FFacebook/USERNAME

Tell us your story... *

You are aged 18 or over *

You consent to Navi Studios and The Claudreen Jackson Show. processing any sensitive personal data that you have provided in your application or as part of the application process. *

Please note to take part in some of our Programs, we will need to process the sensitive personal data you provide to us.

A onetime $50 Donation to the Pervis Jackson Jr Autism Foundation is required in order to be considered for a guest spotlight on The Claudreen Jackson Show. Donations will be required at the time of scheduling your guest spotlight. *

I Understand

All photos and any other materials submitted to producer ('Materials') become the sole and exclusive property of producer and cannot be returned at any time. By submitting Materials, you agree producer may, but is not obligated to, use the Materials in connection with the show, in any way, in any medium, worldwide, in perpetuity. Further, you warrant all Materials are 100% original and do not violate the right of privacy or publicity of, or constitute a defamation against, any person or entity; that the Materials will not infringe upon or violate the copyright or common law rights or any other rights of any person or entity; and that there are and will be no encumbrances, liens, conditions or restrictions whatsoever upon or affecting such Materials. You agree to indemnify producer and broadcaster for all damages and expenses (including reasonable attorney's fees) arising out of any breach or failure of the warranties made herein. *

I Understand