MEDIA APPLICATION - WOMEN GROW LEADERSHIP SUMMIT 2017
Please fill out information below to request credentials for the Women Grow Leadership Summit. Credentials will be confirmed within 48 hours of submission.
Email address
CREDENTIAL REQUESTED
Required
CONTACT INFORMATION
Last Name
Your answer
First Name
Your answer
E-Mail
Your answer
Phone (cell)
Your answer
Phone (office)
Your answer
Address
Your answer
City
Your answer
State
Your answer
Zip
Your answer
AFFILIATION
Media Outlet
Your answer
Assigning Editor
Your answer
Address
Your answer
City
Your answer
State
Your answer
Phone (office)
Your answer
PROPOSED COVERAGE
To be considered, video and photo teams must supply proposals for images captured at summit. For-profit use of footage is not allowed, and waivers must be arranged with all subjects independently.
Please describe your concept featuring the summit.
Your answer
How do you plan to utilize your footage?
Your answer
On what platforms will your footage/images be featured (please include web addresses)?
Your answer
I will not gather content from the summit with the intent to monetize said content.
Submit
Never submit passwords through Google Forms.
This form was created inside of Women Grow. Report Abuse - Terms of Service - Additional Terms