Media Request Form

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Media Request Form

Thank you for reaching out! Please use this form to request an interview with NYS Assemblymember Anna Kelles. Due to scheduling constraints, it is advised to submit a request as far in advance as possible. Once completed, your request will be reviewed by staff, and they will be in touch with you at the phone or email address provided below.

Assemblymember Kelles appreciates your invitation. However, please be aware that she cannot accommodate all requests.

Name *

Organization / News Outlet *

Phone Number *

Email *

Confirm Email *

Preferred Method of Contact *

Phone Number

Email Address

Topic of Discussion

If you are willing to share questions, please add questions below.

Length of Interview *

Format *

Preferred Date of Interview *

YYYY

Preferred Meeting Setting *

In Person

Conference Call

Virtual

Do you have a deadline? If so, what is it?

Submit

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