Request Media Assistance

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	Request for Assistance

I would like to receive a press kit

I would like to receive images
     Slides
     Email Text
     Video b-roll
     Produced video (10 minutes)

Add me to your mailing list

I would prefer to be contacted by
     Email text
     Email attachment
     Fax
     Regular mail

* denotes required field

Name*

Company/Publication Name

Title

Mailing Address

City, State, Zip

Country

Phone*      Fax

Email*

About Your Media Outlet:

Circulation/Audience Size

Geographic coverage area

Frequency of publication/broadcast

Company address (if different from above):
Mailing Address

City, State, Zip

About Your Visit:

Confirmed date of arrival

Confirmed date of departure

Hotel arrangements needed?
Yes    No

If yes, will you mention the hosting hotel(s) in your story?
Yes    No

If complimentary arrangements are not available, will you accept press rates?
Yes    No

If yes, what range?

Number of people in party (include names and titles)

Type of story planned

Special Interests (i.e. shopping, dining, budget, seniors, spas, family, etc.)

Comments/Additional Information