Deep Roots Mountain Revival 2017 Press Application
NAME OF OUTLET *
Your answer
TYPE *
Print, online, TV, etc.
Your answer
NAME OF PERSON SUBMITTING THIS APPLICATION *
Your answer
EMAIL OF PERSON SUBMITTING THIS APPLICATION *
Your answer
NAME OF PERSON APPLYING TO ATTEND *
Your answer
EMAIL OF PERSON APPLYING TO ATTEND *
Your answer
OUTLET STREET ADDRESS 1 *
Your answer
OUTLET STREET ADDRESS 2
Your answer
OUTLET CITY *
Your answer
OUTLET STATE *
Your answer
OUTLET ZIP *
Your answer
OUTLET PHONE NUMBER *
Your answer
OUTLET WEBSITE ADDRESS *
Your answer
OUTLET FACEBOOK ADDRESS *
Please enter the link to your publication's Facebook page. If you do not have a Facebook page, enter "none" in this space.
Your answer
OUTLET TWITTER ADDRESS *
Please enter the link to your publication's Twitter profile. If you do not have a Twitter profile, enter "none" in this space.
Your answer
OUTLET CIRCULATION / IMPRESSIONS *
PRINT - Circulation; DIGITAL - Unique Monthly Visitors; BROADCAST - Listenership. If this does not apply to you, enter "N/A".
Your answer
EDITOR'S NAME *
Your answer
EDITOR'S EMAIL ADDRESS *
Your answer
EDITOR'S DIRECT PHONE NUMBER *
Your answer
# OF ATTENDING MEDIA CREDENTIALS REQUESTED *
Your answer
# OF ATTENDING PHOTO PASSES REQUESTED *
If you are applying for a photo pass, you will NOT need a media pass. Attendees require only one credential per person
Your answer
PLEASE EXPLAIN WHAT YOU & YOUR PUBLICATION WOULD LIKE TO ACCOMPLISH AT THE FESTIVAL *
If you are interested in running a promotion, please reach out to shelly@masonjarmedia.com
Your answer
Submit
Never submit passwords through Google Forms.
This form was created inside of Mason Jar Media. Report Abuse - Terms of Service - Additional Terms