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document.write('<script type=\"text/javascript\" src=\"https://assets.bravenet.com/bn/js/emailfwd/bn_email_forms.min.js\"></script><link rel=\"stylesheet\" href=\"https://pub33.bravenet.com/emailfwd/v2/bnet-form.css.php?usernum=2798844518&formid=3274&formpadding=0\"><form method=\"post\" class=\"bnet-form\" enctype=\"multipart/form-data\" action=\"#bn-ajax-post:2798844518:33:3274\"><div class=\"bn-form-header\"><div class=\"bn-form-legend\"><div>REL-MAR McConnell Company, Broadcast Division, Guest Submission Form for XZBN &amp; CANCOM Broadcast Network</div></div> <div class=\"bn-form-desc\"><p>PLEASE READ CAREFULLY');
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document.write('By submitting this Guest Submission Form, including any photographs, audio recordings, videos, written materials, or other media (“Submitted Media”) through The ‘X’ Zone Radio/TV Show website, I acknowledge and agree that I grant The ‘X’ Zone Radio/TV Show, The ‘X’ Zone Broadcast Network, the CANCOM Broadcast Network, REL-MAR McConnell Media Company, and their respective agents, broadcast partners, affiliates, independent producers, hosts, producers, researchers, investigators, employees, successors, and assigns the exclusive right and permission to use, reproduce, edit, adapt, publish, broadcast, rebroadcast, distribute, display, promote, and otherwise use all or any portion of the Submitted Media for any lawful purpose they consider necessary or appropriate.');
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document.write('This permission applies to The ‘X’ Zone Radio/TV Show; all other programs produced, co-produced, represented, aired, broadcast, syndicated, streamed, or distributed by REL-MAR McConnell Media Company; and programs created or hosted by independent producers and hosts that are aired, broadcast, streamed, syndicated, or distributed through REL-MAR McConnell Media Company, The ‘X’ Zone Broadcast Network, the CANCOM Broadcast Network, or their affiliated stations, platforms, networks, and distribution partners (“Covered Programs”).');
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document.write('Authorized uses may include, but are not limited to:');
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document.write('Television broadcasts and rebroadcasts;');
document.write('Radio broadcasts and rebroadcasts;');
document.write('Internet broadcasts, streaming, podcasting, and digital distribution;');
document.write('Use in any Covered Program;');
document.write('Syndication and distribution through affiliated stations, networks, platforms, and broadcast partners;');
document.write('Press releases and publicity materials;');
document.write('Website and social-media content or promotion;');
document.write('“Photo of the Week” and similar features;');
document.write('Print media;');
document.write('Program archives, compilations, excerpts, clips, and promotional materials; and');
document.write('Any other lawful use deemed appropriate by The ‘X’ Zone Radio/TV Show, The ‘X’ Zone Broadcast Network, the CANCOM Broadcast Network, REL-MAR McConnell Media Company, or the producers and hosts of the Covered Programs.');
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document.write('I waive and release any claims or causes of action arising from the authorized use of the Submitted Media. I further agree to indemnify and hold harmless The ‘X’ Zone Radio/TV Show, The ‘X’ Zone Broadcast Network, the CANCOM Broadcast Network, REL-MAR McConnell Media Company, the independent producers and hosts of the Covered Programs, and their respective agents, partners, affiliates, representatives, employees, successors, and assigns from any claim, loss, injury, damage, or liability resulting from or relating to the Submitted Media or its authorized use.');
document.write('');
document.write('I certify that I am the creator and/or lawful owner of the Submitted Media, possess all rights and permissions required to submit it and authorize its use, and am 18 years of age or older.');
document.write('');
document.write('I understand that any or all information and materials submitted through this form may be reviewed, verified, and vetted.');
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document.write('Please mail books and other media-related materials to:');
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document.write('The ‘X’ Zone Broadcast Network');
document.write('7 Gale Crescent');
document.write('St. Catharines, Ontario L2R 7M8');
document.write('Canada</p></div></div><div class=\"fields-wrapper ui-sortable-handle\"><label class=\"bn-row\"><span class=\"bn-label\">Date When Completing This Form </span> <span class=\"bn-input\"><input type=\"text\" name=\"Field-169861146924313\" placeholder=\"This is a requuired field and must be completed.\" validator=\"\" value=\"\"></span></label></div><div class=\"fields-wrapper\"><div class=\"bn-row rowcb\"><span class=\"bn-label\">Which Show Are You Being A Guest  On? <span class=\"bn-required\">*</span></span> <span class=\"bn-input\"><span class=\"bn-optionwrapper\"><label class=\"bn-checkbox\"><input type=\"checkbox\" name=\"Field-178948455772360[]\" value=\"The \'X\' Zone with Rob McConnell\" required=\"required\" checked=\"checked\"> <span class=\"bn-inner-label\">The \'X\' Zone with Rob McConnell</span></label></span><span class=\"bn-optionwrapper\"><label class=\"bn-checkbox\"><input type=\"checkbox\" name=\"Field-178948455772360[]\" value=\"Paranormal StakeOut with Larry Lawson\" required=\"required\"> <span class=\"bn-inner-label\">Paranormal StakeOut with Larry Lawson</span></label></span><span class=\"bn-optionwrapper\"><label class=\"bn-checkbox\"><input type=\"checkbox\" name=\"Field-178948455772360[]\" value=\"Reimaging Humanity\'s Future and Yours with Dr. David Gruder\" required=\"required\"> <span class=\"bn-inner-label\">Reimaging Humanity\'s Future and Yours with Dr. David Gruder</span></label></span><span class=\"bn-optionwrapper\"><label class=\"bn-checkbox\"><input type=\"checkbox\" name=\"Field-178948455772360[]\" value=\"Manna Ministries with Evangelist Patrick Sims\" required=\"required\"> <span class=\"bn-inner-label\">Manna Ministries with Evangelist Patrick Sims</span></label></span><span class=\"bn-optionwrapper\"><label class=\"bn-checkbox\"><input type=\"checkbox\" name=\"Field-178948455772360[]\" value=\"The GrandMaster Ze\' Show with GrandMaster Ze\'\" required=\"required\"> <span class=\"bn-inner-label\">The GrandMaster Ze\' Show with GrandMaster Ze\'</span></label></span><span class=\"bn-optionwrapper\"><label class=\"bn-checkbox\"><input type=\"checkbox\" name=\"Field-178948455772360[]\" value=\"Mr. Destiny Show with Robert Lee Camp\" required=\"required\"> <span class=\"bn-inner-label\">Mr. Destiny Show with Robert Lee Camp</span></label></span></span></div></div><div class=\"fields-wrapper ui-sortable-handle\"><label class=\"bn-row\"><span class=\"bn-label\">Your Field of Expertise </span> <span class=\"bn-input\"><textarea name=\"expertise\" placeholder=\"Please Only List Your Main Area Of Expertise Here.\" validator=\"\"></textarea></span></label></div><div class=\"fields-wrapper ui-sortable-handle\"><div class=\"bn-row rowcb\"><span class=\"bn-label\">Salutation: </span> <span class=\"bn-input\"><span class=\"bn-optionwrapper\"><label class=\"bn-radio\"><input type=\"radio\" name=\"Salutation\" value=\"Mr.\"> <span class=\"bn-inner-label\">Mr.</span></label></span><span class=\"bn-optionwrapper\"><label class=\"bn-radio\"><input type=\"radio\" name=\"Salutation\" value=\"Mrs.\"> <span class=\"bn-inner-label\">Mrs.</span></label></span><span class=\"bn-optionwrapper\"><label class=\"bn-radio\"><input type=\"radio\" name=\"Salutation\" value=\"Ms.\"> <span class=\"bn-inner-label\">Ms.</span></label></span><span class=\"bn-optionwrapper\"><label class=\"bn-radio\"><input type=\"radio\" name=\"Salutation\" value=\"Dr.\"> <span class=\"bn-inner-label\">Dr.</span></label></span><span class=\"bn-optionwrapper\"><label class=\"bn-radio\"><input type=\"radio\" name=\"Salutation\" value=\"Rev.\"> <span class=\"bn-inner-label\">Rev.</span></label></span></span></div></div><div class=\"fields-wrapper ui-sortable-handle\"><label class=\"bn-row\"><span class=\"bn-label\">First Name </span> <span class=\"bn-input\"><input type=\"text\" name=\"FirstName\" placeholder=\"This is a required field\" validator=\"\" value=\"\"></span></label></div><div class=\"fields-wrapper ui-sortable-handle\"><label class=\"bn-row\"><span class=\"bn-label\">Family Name </span> <span class=\"bn-input\"><input type=\"text\" name=\"family_name\" placeholder=\"This is a required field\" validator=\"\" value=\"\"></span></label></div><div class=\"fields-wrapper ui-sortable-handle\"><label class=\"bn-row\"><span class=\"bn-label\">Telephone number for Interview - please include your area code </span> <span class=\"bn-input\"><input type=\"text\" name=\"Field-170188431099032\" placeholder=\"\" validator=\"\" value=\"\"></span></label></div><div class=\"fields-wrapper ui-sortable-handle\"><label class=\"bn-row\"><span class=\"bn-label\">Your WHATSAPP address is required for our interview. 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