Media Information Form

Media Company: ___________________________________________________________

Contact Person: ____________________________________________________________

Address: _________________________________________________________________

_________________________________________________________________________ 

Phone: _________________________________

Fax: ___________________________________

Email: __________________________________

 

Type of Media:

Television Radio Newspaper Magazine __________________________

 

Media Kit Requested: ______________________19 ___

Media Kit Received: _______________________19 ___

Comments:

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

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