Name of Organization (Show, Publication, Newspaper) *
Your answer
What is the estimated reach of your outlet? *
Your answer
Will you be sharing the story/interview across your social media? If yes, what platforms and estimated social media reach? Please include your media handles. *
Your answer
Length of Interview/Segment *
Your answer
Proposed Date/Time (PST) Please add additional dates/times as options if possible. If it is flexible, please in just include a Deadline date. *