State Senator Eddie Lucio, Jr. Media Request Form
Please complete the form to process your request. You may direct any questions to the scheduler at 956-548-0227.
Email address *
Deadline Date & Time: *
Your answer
Proposed Interview Date & Time: *
Your answer
Publication Date: *
MM
/
DD
/
YYYY
Person Requesting Interview: *
Your answer
Employer/Affiliation: *
Your answer
Title/Position: *
Your answer
Address: *
Your answer
City/State: *
Your answer
Phone:
Your answer
Mobile: *
Your answer
Subject Matter Of The Interview: *
Your answer
Type Of Media Organization Represented: *
If you selected unaffiliated, project has been contracted for purchase by ( please specify):
Your answer
For The Purpose Of This Request, You Are: *
Media Format (select all that apply): *
If you selected Phone, In Studio, On Site, Skype/Facetime please provide additional information
Your answer
Will questions related to the subject matter be provided in advance? *
Will you be taking photos of Senator Lucio with this interview? *
If Senator Lucio is not available, would you like a prepared statement or print responses? *
Afterhours/Weekend Contact: *
Your answer
Mobile: *
Your answer
A copy of your responses will be emailed to the address you provided.
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms