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Request Dr. Simone for Interview or Media Appearance
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First Name
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Last Name
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Name of Company
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Type of Company (TV, Movie, Radio, Podcast, Blog, Vlog News, etc...)
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Phone Number
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Please provide a description of your company/service and the purpose for requesting an appearance. (Include date(s), time(s) and relevant event-links if applicable.)
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What type of interview/appearance will this be?
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