Book As Presenter

COMPANY INFORMATION

Name: *

Address: *

Show name/Newspaper Section: *

PRIMARY CONTACT INFORMATION

Contact Name: *

Title: *

Work Phone: *

Cell Phone: *

Email: *

Address: *

Fax: *

DEADLINES

Deadline for response: *

Deadline for interview: *

Publish/ On-Air Date of Interview: *

FORMAT OF FINISHED PIECE

 Newspaper Television Radio Magazine Other

TYPE OF PRESENTATION

 Phone On Video Live In person without a photographer In person with a photographer

TOPIC AND STORY CONTEXT

CIRCULATION/SIZE OF AUDIENCE OF FINISHED PIECE

AUDIENCE DEMOGRAPHICS

LENGTH OF PRESENTATION

DESIRED LOCATION OF PRESENTATION

COMPLETE LIST IF QUESTIONS FOR PRESENTATION

ADDITIONAL COMMENTS/INFORMATION

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