PR/Media Request Form

Thank you for reaching for out! Please include as much information as possible, and we will get back to you promptly.

Today's Date *

YYYY

Your Name *

Phone Number *

Email *

Who are you requesting to be interviewed? *

Type of Media *

Name of Organization (Show, Publication, Newspaper) *

What is the estimated reach of your outlet? *

Will you be sharing the story/interview across your social media? If yes, what platforms and estimated social media reach? *

Length of Interview/Segment *

Proposed Date/Time (PST) Please add additional dates/times as options if possible. *

Requested Location (please specify Zoom, Skype, in-person, etc.) *

Requested Arrival Time *

Select all topics to be discussed: *

Faith

Do Something Church (Outreach)

The Third Option (Racial Reconciliation)

The Third Option (Similarity Training)

Leadership

Current Event

Other:

Required

Point of Contact *

Time of Broadcast/Issue *

Deadline for Response *

Any other details? *

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