Pour The Core: Long Island 2019 Media Pass Request Form
Please fill out the following form to request a media pass for Pour the Core: Long Island to be held on September 28, 2019 at Heckscher State Park in East Islip, NY.
Email address *
Your last name *
Your answer
Your first name *
Your answer
Your professional title *
Your answer
Media company *
Please provide us the company for which you write/cover for.
Your answer
Phone number *
Please provide us your business phone number in the following format: XXX-XXX-XXXX.
Your answer
Company website *
Your answer
Type of media *
Required
Example of your work *
Please provide us a link to an example of your work or past coverage of an event that can be found on the internet.
Your answer
A copy of your responses will be emailed to the address you provided.
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This form was created inside of Starfish Junction Productions.