About your media company
Email address *
Media Outlet Name(s): *
Your answer
Ownership of Media Outlet​:
Your answer
Mailing address: *
Your answer
Type of Media Outlet (select one): ​
Year Founded:
Your answer
Contact Name:​ *
Your answer
Title: *
Your answer
Email address: *
Your answer
Phone Number: *
Your answer
How many people are on your staff (including yourself):
Your answer
Type of Media (select all that apply): *
Required
Frequency of Publication:​ *
Primary Audience: *
Please define your audience further:
Your answer
Primary Region Coverage: *
Your answer
Secondary Region Coverage:
Your answer
Type of content coverage​ (select all that apply):​ *
Required
List all website URL and social media channels handles below:
Your answer
Describe any niche or key information about the media outlet:
Your answer
Next
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.